Chapter#01

Introduction to Clinical Psychology

Content

 Historical Background
 Role of Clinical Psychologist
 Areas of Clinical Psychology

Historical Background

Early influences on the field of clinical psychology include the work of the Austrian
Psychoanalyst Sigmund Freud, who was one of the first to focus on the idea that mental illness
was something that could be treated by talking with the patient, and it was the development
of his talk therapy approach that is often cited as the earliest scientific use of clinical psychology.

American Psychologist Lightner Witmer opened the first psychological clinic in 1896
with a special focus on helping children who had learning disabilities. It was also Witmer who
first introduced the term “clinical psychology” in a 1907 paper.

Witmer, a former student of Wilhelm Wundt, defined clinical psychology as “the study of
individual, by observation or experimentation, with the intention of promoting change”.

By 1914, 26 other clinics devoted to clinical psychology had been established in the
United States. Today, clinical psychology is one of the most popular sub-fields and the single
largest employment area within psychology.

Evolution During the World Wars:

Clinical psychology became more established during the period of World War I as
practitioners demonstrated the usefulness of psychological assessments. In 1917, the American
Association of Clinical Psychology was established, although, it was replaced just two years
later with the establishment of American Psychological Association (APA).

During World War II, clinical psychologists were called upon to help treat what was then
known as shell shock, now referred to as post-traumatic stress disorder (PTSD). The demand
for the professionals to treat the many returning veterans in need of care contributed to the
growth of clinical psychology during this period.

During 1940s, the United States had no programs offering a formal clinical psychology
degree. The U.S. Veterans Administration set up several doctoral level training programs and by
1950s, more than half of all the Doctor of Philosophy (PhD)- level degrees in psychology were
awarded in the area of clinical psychology.

Change in Focus:

While the early focus in clinical psychology had mainly been on science and research,
graduate programs began adding additional emphasis on psychotherapy. In clinical psychology
PhD program, this approach is today referred to as the scientist-practitioner or Boulder Model,
a training model for graduate programs that provide applied psychologists with a foundation in
research and scientific practice. Created by David Shakow, this model of training received
accreditation in 1949 by the psychological community and American Psychological
Association. The goal of scientist-practitioner model is to increase scientific growth within
clinical psychology in United States. It calls for graduate programs to engage and develop
psychologist’s background in psychological theory, field work and research methodology. The
scientist-practitioner model urges clinicians to allow empirical research to influence their applied
practice; while simultaneously allowing their experiences during applied research to shape their
future research questions. Therefore, continuously advancing, refining, and perfecting the
scientific paradigms of the field.

Later, the Doctor of Psychology (PsyD) degree option emerged, which emphasized
professional practice more than research. This practice-oriented doctorate degree in clinical
psychology is known as the practitioner-scholar or vail model. In 1973, this model was
proposed at the historic Vail Conference on Professional Training in Psychology in Vail,
Colorado. Vail model is a training model for graduate programs that is focused on clinical
practice. According to this model, a psychologist is a scholar, a consumer of research, and a
highly trained professional practitioner who applies knowledge and techniques to solve
problems of clients.
Definitions of Clinical Psychology:

The word “Clinical”, derived from the Latin and Greek words for Bed, suggests the
treatment of individuals who are ill. But clinical psychology has come to means a broader area
than just mental illness of individual. Among the ultimate aims of clinical psychology are the
psychological well-being and beneficial behaviors of persons. Clinical psychology is concerned
with the practical application of research methodologies and findings in the diagnosis and
treatment of mental disorders.

According to J.H. Resnick (1991):

“The field of clinical psychology involves research, teaching and services relevant to the
applications of principles, methods, and procedures for understanding, predicting, and alleviating
intellectual, emotional, biological, psychological, social, and behavioral maladjustment,
disability, and discomfort applied to a wide range of client population”.

Another definition is:

Clinical Psychology is the scientific study, diagnosis and treatment of people, who have
psychological problems adjusting to themselves and the environment. Clinical psychologists deal
with both normal and abnormal behaviors. They administer and interpret psychological tests, and
assist in the diagnosis and treatment of mental disorders. They also study the structure and
development of personality.

According to American Psychological Association (1981):

“Clinical psychology attempts to use the principles of psychology to better understand, predict
and alleviate intellectual, emotional, psychological, and behavioral disability and discomfort”.

According to Rodnick (1985):

“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”.

Thus, the clinical psychology uses what is known about the principles of human behavior
to help people with 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.

To summarize,

 Clinical psychology is a broad approach to human problems (both individual and

interpersonal) consisting of assessment, diagnosis, consultation, treatment, program
development, administration, and research with regard to numerous populations,
including children, adolescents, adults, the elderly, families, groups etc.
 Clinical psychologists work with a broad range of populations, including the following:
individuals (infants, children, adolescents, adults, and the elderly), couples (regardless of
gender composition), families (traditional, multi-generational, and blended families),
groups, organizations and systems.

Role of Clinical Psychologist

Although clinical psychology is a distinct area within the field of psychology, clinical
psychologists are remarkably heterogeneous in the day-to-day work that they do and in the
settings in which they work. Following are some points that will clarify the role played by the
clinical psychologists in different settings:

1. Research: Most research in the clinical psychology is carried out or supervised by the
faculty members in universities and colleges, although some research is conducted by
clinical psychologists working in applied settings such as hospitals, and clinics. Research
in clinical psychology is a widely varied enterprise, ranging from investigation of
problems that can be observed and studied in animals in laboratory settings to study
the effectiveness of a certain type of psychotherapy for a specific clinical problem
with patients in clinics or hospitals. For example, important research on the nature and
development of anxiety disorders has been carried out using a variety of methods.
2. Teaching: Clinical psychologists who work in colleges and universities are also involved
in teaching, both with undergraduates who are majoring in psychology and graduate
students who are pursuing their master’s or doctorate in clinical psychology. Clinical
psychology faculty typically teach undergraduate courses such as abnormal psychology,
 personality, introduction to clinical psychology, and child clinical psychology. A large
amount of teaching by the clinical psychologists involves clinical teaching and
supervision of graduate students who are learning skills in psychological research,
assessment and intervention. Graduate students are trained in psychological
assessment and psychotherapy in clinical settings under the direct supervision of
clinical psychologist.
3. Assessment: One of the unique skills of clinical psychologists involve the ability and
training to carry out detailed psychological assessments. Assessment includes the
administration and interpretation of standardized psychological tests, the use of
structured clinical interviews, systematic observation of client’s behavior, and an
examination of the settings or environment in which the individual functions day to
day.

Psychologists who work in clinical practice, whether in a clinic setting or in their

own independent office, devote varying amount of time to assessment. For example,
one psychologist may devote a great deal of his or her time to conducting evaluations of
psychological functioning of individuals who have filed for worker’s compensation for
psychological disabilities related to work stress. Another might conduct frequent
evaluations of children’s psychological status as it pertains to decisions regarding custody
after a divorce, and still another might conduct evaluation of individuals who have been
incarcerated for committing sexual offenses.

4. Treatment: Perhaps the most common image of a clinical psychologist is that of

someone who conducts individual, group, or family psychotherapy. This image is
reasonably accurate because practicing psychologists devote a great proportion of their
time to the delivery of psychological treatment using any kind of dozens of approaches to
psychotherapy. Treatment may be conducted with individual children, adolescents or
adults or with couples, families, or groups of individuals with similar types of
problems. A typical individual psychotherapy session lasts 50 minutes rather than an
hour to allow the psychologist time to write notes and prepare for subsequent
appointments and may follow a relatively prescribed format depending on the orientation
of psychologist.
5. Prevention: Although the prevention of psychopathology is a high priority for all types
of mental health practitioners, significantly less time and effort is devoted to the
prevention than to the treatment of mental health problems. Prevention programs
include teaching social skills to school-age children, teaching adults ways to cope
with work-related stress and its consequences, helping families cope with possible
effects of divorce, and teaching patients with physical illness how to cope with their
disease and the adverse side effects of treatment. Psychologists engage in prevention-
related activities as a part of their duties in mental health centers and in consultation with
organizations such as businesses and schools. Clinical psychologists are likely to
become more involved in prevention efforts, in part as a result of pressure from
health maintenance organizations and insurance companies to reduce the cost of
health care. Preventing the onset of psychological and medical disorders can be, in the
long term, much more cost effective than treating disorders once they arise.
6. Consultation: Clinical psychologists also offer their services through advice and
consultation to other professionals. For example, a clinical psychologist might serve as a
consultant in a school, providing information and guidance to teachers and counselors
who themselves work directly with the children. Another clinical psychologist might
provide advise and consultation to a business that is struggling with a high rate of alcohol
abuse among its employees. The base of operations for consultation services performed
by clinical psychologists may be the independent practice or a large consulting firm that
specializes in this type of work.
7. Administration: Although the clinical psychologists are not specifically trained to be
administrators, clinical psychologists may assume administrative positions in the
various settings in which they serve. Such positions include serving as the director of
clinical psychology training program within a university psychology department,
chairperson of a psychology department, director of a mental health center, or director of
psychological services in a hospital or health maintenance organization.

Note: A clinical psychologist most often has a doctoral degree. The degree could be a
Doctor of Psychology, known as PsyD, or a Doctor of Philosophy, called a PhD. The
difference between the two lies in the focus of education. A doctor of psychology will have
more clinical focus, allowing students to work directly with clients in the field and conduct
both assessments and therapy. A doctor of philosophy student will spend more time
conducting actual scientific research than performing therapy.

Areas of Clinical Psychology

There are three distinct areas of clinical psychology, which are listed below:
1. Cognitive-Behavioral approach
2. Psychodynamic approach
3. Humanistic approach
1. Cognitive-Behavioral approach: This approach to the clinical psychology
developed from the behavioral and cognitive schools of thought. Clinical
psychologists using this perspective will look at how the client’s feelings, behaviors
and thoughts interact. Cognitive Behavioral Therapy (CBT) often focuses on
changing thoughts and behaviors contributing to psychological distress. Specific
types of therapy that are rooted in CBT include:
 Acceptance and commitment therapy.
 Cognitive processing therapy
 Dialectical behavior therapy
 Rational emotive behavior therapy
 Trauma-focused cognitive behavioral therapy
 Mindfulness-based cognitive therapy
2. Psychodynamic approach: This perspective grew from Sigmund Freud’s work. He
believed that that the unconscious mind plays a vital role in our behavior.
Psychologists, who utilize the psychoanalytic therapy, may use techniques such as
free association to investigate a client’s underlying unconscious motivations. Modern
psychodynamic therapy utilizes talk therapy to help people gain insight, solve
problems and improve relationships. Research found that this approach to treatment
can be as effective as other therapy approaches.
3. Humanistic approach: This approach to the clinical psychology grew from the work
of humanistic thinkers such as Abraham Maslow, and Carl Roger. This perspective
looks as the client more holistically and is focused on such things as self-
actualization. Some types of humanistic therapy that a clinical psychologist might
practice include client-centered therapy, existential therapy, gestalt therapy, narrative
therapy, or logotherapy.