PS380: Clinical Psychology

PS380: Clinical
Instructor: Sara Barnett, M.S., Ed.M., M.A.
Unit 2: Evolution of Clinical Psychology
Warm-Up Questions
S What stigma exists regarding those who attend therapy?
S Why is said stigma existent in some communities and not in
Warm-Up Questions
S What are some differences in the treatment of the mentally
ill today versus 100 years ago?
S Announcements
S Discussion of Chapter 1: Evolution of Clinical Psychology
S Mini-Discussion of Chapter 2: Current Controversies
S Questions, Comments, Reflections
S Nice job on the discussion boards!
S Stay committed to the practicum assignments
Evolution of Clinical Psychology
S Psychology dates back to scientific revolutions in Europe
(16th – 19th centuries), and arguably back to the Greek
philosophers (5th century BC) and Confucius (6th century
S Clinical psychology did not exist until the late 1800s/early
1900s (when study of psychology was complemented by
applied practice)
Evolution of Clinical Psychology
S For much of history, the mentally ill were:
S Considered to be possessed by evil spirits/devil, stricken
with illness due to bad behavior and/or as dangerous as
S Shunned by society, discarded by family, locked away
and/or dehumanized
S Early pioneers of the modern mental health movement
helped to change the above…
Early Pioneers
S Who were some of the early pioneers of clinical
Early Pioneers
S England: William Tuke (1732-1822)
Visited asylums and argued that patients should be
treated with greater dignity, kindness and decency
- Raised funds to establish “retreats”, which then spread
throughout Europe and the United States
Early Pioneers
S France: Philippe Pinel (1745-1826)
Challenged the imprisonment of the mentally ill
Argued that the mentally ill deserved compassion (empathy
rather than cruelty)
Created new institutions wherein the mentally ill were given
healthy food and allowed activities v. kept in a dungeon, beaten
and chained to walls and beds
Required staff to conduct case histories, complete progress
notes, and maintain case files
Early Pioneers
S America: Eli Todd (1768-1832)
Physician who saw greater need for humane facilities for the
mentally ill (only 3 existed in America)
Recognized burden/shame felt by families
Opened “retreats” and encouraged staff to focus on/promote
patients strengths versus weaknesses
Early Pioneers
S America: Dorothy Dix (1802-1887)
Worked as Sunday school teacher in Boston jail – argued many
inmates were mentally ill, not criminal
Traveled through cities, collected data on mentally ill and their
treatment, presented findings to community leaders
Ultimately contributed to the opening of 30 mental institution
in U.S. wherein patients were deserving of understanding and
Early Pioneers
S Germany: Lightner Witmer (1867-1956)
Opened first clinical psychology clinic (1896) at the
University of Pennsylvania and encouraged others to do
the same (1914 – 20 clinics; 1935 – 150 clinics)
- Aimed to “throw light upon the problems that confront
- Largely focused on children (learning and behavioral
- * Did not keep comprehensive records
Early Diagnosis
S Stage was set by the pioneers… now there was work to be done!
S Early diagnostic terminology included:
Neurosis and Psychosis
Exogenous Disorders and Endogenous Disorders
Emil Kraeplin (1855-1926) identified more specific disorders
(paranoia, depressive psychosis, autistic personality),
ultimately leading to the creation of the Diagnostic and
Statistical Manual of Mental Disorders (DSM)
S What is the DSM?
S What are its benefits?
S Manual of psychological disorders published by the
American Psychiatric Association
S Covers all mental health disorders for both
children and adults
S Lists known causes of disorders, statistics in
terms of gender, age at onset, and prognosis as
well as some research concerning optimal
treatment approaches
DSM-IV Major Depressive Episode
Major Depressive Episode
Five (or more) of the following symptoms have been present during the same 2week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure (
Note: Do note include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations)
Depressed mood most of the day, nearly every day, as indicated by either subjective
report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
Note: In children and adolescents, can be irritable mood.
Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation made
by others).
Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day.
Note: In children, consider failure to make expected weight gains.
DSM-IV- Major Depressive Episode
S (4) insomnia or hypersomnia nearly every day.
S psychomotor agitation or retardation nearly every day (observable
by others, not merely subjective feelings of restlessness or being
slowed down).
fatigue or loss of energy nearly every day.
feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-reproach or
guilt about being sick).
diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by
recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.
DMS-IV: Major Depressive Episode
The symptoms do not meet criteria for a Mixed Episode.
The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
The symptoms are not due to the direct physiological effects of
a substance or a general medical condition
The symptoms are not better accounted for by Bereavement,
i.e., after the loss of a loved one, the symptoms persist for
longer than 2 months or are characterized by marked functional
impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor retardation.
Influence of Intelligence Study
The Intelligence Testing Movement and Clinical Psychology
S Emergence of clinical psychology coincided with rise of study
of intelligence (late 1800s/early 1900s)
S General intelligence was thought to overlap with physical and
mental abilities (link between low IQ and mental health
struggles – now known not always the case)
S Assessments created for intelligence… then created for mental
health testing/personality testing
S What do you know about assessment as it pertains to the
field of psychology?
S What are some different types of assessment?
S What are some commonly used assessments?
S Clinical psychologists were largely academicians w/ small
practices until the mid 1900s when number of practices
grew… Why did this boom occur?
S The Influence of WWII
Mental tests used to position military and better understand
human mind; Ultimately additional tests were created for
personality, etc.
US veterans returned home “shell shocked” and in need of
mental health care
Influential figures such as Freud forced to flee home countries
and ideas on psychology in turn spread throughout Europe and
the world
Evolution of Psychotherapy
S Early 1900s: Psychodynamic theories proposed
S 1950s: Behaviorism gained popularity
* 1953: APA Ethical Code established
S 1960s: Humanistic approach gained popularity
S 1970s: Family therapy and other specialties developed
* Cognitive psychology meanwhile grew (arguably most popular today)
S 1970s/80s: Insurance coverage, more diversity among professionals
S Today – Clinical psychology stands as an accepted profession and
Current Controversies
S Prescriptions
S Manualized Therapy
S Insurance Coverage
S Diagnosis
S Cultural Issues
Questions, Comments, Reflections
S ???

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