临床与咨询心理学导论 4 - History 2

L4 History of Clinical Psychology 2: Emergence and Evolution of the Field

参考文献/图片来源：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

4.1 Emergence of “Clinical Psychology”

Lightner Witmer (1867-1956)

- Founded the first psychological clinic at UPenn (1896)

- Began after a teacher sought help from Witmer because of concerns about a student

- Focused on children with learning and behavioral difficulties

Psychology’s First Clinic

Witmer developed a team approach

- Physician: Provided medical exam

- Social worker: Gathered family/school history

- Witmer, his assistants: Administered tests

Used this information to guide path forward

Clinic served 10,000 children by 1931

- Inspired more than 20 clinics by the start of WWI

- Number up to 150 clinics by 1935

Founded the first scholarly journal for clinical psychology

- “The Psychological Clinic”

- Forum for publishing case studies

- 1907 - 1935

- First published use of the term “Clinical Psychology” in the first article

Proposed a psychological expert:

“…who should find his career in connection with the school system, through the examination and treatment of … children”

4.2 Development of an Identity (as Clinical Psychologist)

American Psychological Association (1892)

- Group of psychologists at Clark University in MA

- 31 elected members initially

- G. Stanley Hall, First APA President

- Academic & Research

First APA meeting: December, 1892

American Association of Clinical Psychologists (1917)

- APA was concerned these psychologists would leave

- Formed a special “section” for clinical psychologists in 1919

APA dominated by academics and researchers

- Through the 1930s

- Psychologists doing applied work created their own group:

- American Association of Applied Psychology (1937)

APA re-structured in 1943

- Conference for multiple organizations

- “Umbrella” organization with special interest divisions

54 divisions within APA

4.3 Evolution of the Profession

4.3.1 Diagnosis: Classifying Mental Health Problems

Early attempts at classification with Census data (人口普查Statistics)

- 1840: “Idiocy/insanity” recorded in the Census

By 1880 7 mental health categories established:

- Mania狂躁

- Melancholia忧郁症

- Monomania躁狂症: Characterized by a preoccupation with a single idea; considered a type of “partial insanity”

- Paresis轻瘫: Neuropsychological condition caused by syphilis

- Dementia痴呆

- Dipsomania酗酒: Condition referring to alcohol craving

- Epilepsy癫痫: Disorder characterized by seizures; not considered a mental health problem

Late 1800s: Efforts at diagnosis (not just classification)

- Focus on specific symptoms and prognosis

Emil Kraepelin - father of descriptive psychiatry

- Physician from Germany

- Specialized in psychiatry (1878)

- Became a professor of psychiatry at the Heidelberg University in 1890

- Focused much of his career on developing a classification system for mental illnesses

- Kraepelin’s Classification System

Developed and published a classification system

- Textbook of Psychiatry

- First edition published in 1883

- Nine editions completed over the course of his life

Differentiated between two categories of disorders:

Exogenous Disorders: Disorders caused by external factors

Endogenous Disorders: Disorders caused by internal factors

- Assigned names to specific disorders

- Dementia praecox (similar to what we now call schizophrenia精神分裂症)

- Many different terms (eg depressive) that influenced the field

4.3.2 Diagnostic and Statistical Manual of Mental Disorders (Dsm)

First edition published in 1952 by the American Psychiatric Association

- Included over 100 diagnoses

- Major focus on psychotic symptoms

Brief descriptions for most categories

- 200 words or less

- Terms left to interpretation

Focus on inpatient applications and influence of the psychoanalytic perspective

- The use of term “Reactions” is popular

Dsm Revisions

- Dsm-II (1968)

- Similar to Dsm-I in many ways

- Increased focus on outpatient treatment

- More anxiety and depressive disorders

- More disorders diagnosed in childhood and adolescence

- Description still lacking details

Problems with Dsm-II identified

- Empirical evidence on inconsistent application of criteria

- Clinicians identifying the vague criteria as a major problem

- Disorders identified by small number of academics; not identified through research studies

- Dsm-III (1980) - 228 diagnostic categories (163 with criteria)

Major changes from Dsm-II (1968) to Dsm-III (1980)

Dramatic change in amount of detail

- Specific diagnostic criteria (on-site & observation)

- Lengthy descriptions of each disorder

- Information on onset and course

Theoretical shift

- Psychoanalytic perspective dominates in first two editions

- Efforts to be atheoretical by the third edition

- Increased focused on treatment applications

- Dsm-III-R (1987): more diagnoses, more about Sleep disorders

- Dsm-IV (1994)

- 368 diagnoses

- Much longer book (886 pages)

- Expanded diagnoses that requiring further study

- Dsm-IV-TR (2000)

- TR = Text revision

- Very minimal content changes

- Same number of diagnoses

- Changes to supporting narrative text

- Dsm-5 (2013, current as of 2020)

- More than 500 mental health professional involved in workgroups - Information posted online throughout the process

- Includes a lot of detailed information: 947 pages long!

4.3.3 Assessments

Evolution of Intelligence Assessment

Memory, reaction

Major work of psychologists in the early 20th century

General intelligence (“g”)

Alfred Binet and the Binet-Simon Scales (1905, French)

Originally identified children with school difficulties

Translated into English and expanded: Stanford-Binet Intelligence Scale

Major increase in use during WWI

- Army hired a psychologist, Alfred Yerkes, to assess recruits (2 millions soldiers)

- Army Alpha Test (written) / Army Beta Test (oral)

- These tests were precursors to modern assessments

Wechsler-Bellevue Test (1939)

- Popular intelligence test developed specifically for adults

Revised in 1955 - Renamed: Wechsler Adult Intelligence Scale (WAIS)

- Most recent edition = WAIS-IV

Evolution of Personality Assessment

Developed soon after IQ tests

Rorschach Inkblot Method (1921) - Projective Test = Present ambiguous stimuli and people “project” what they see (eg vague picture)

Objective measures become more popular later: Usually paper-and-pencil (MC/TF)

Minnesota Multiphasic Personality Inventory (MMPI) - objective

Originally published in 1943

Major Revised in 1989: MMPI-2

- Measures personalities that might link to psychopathology

NEO Personality Inventory - objective, general personality trails

“Big Five” Divisions: Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness

4.3.4 Evolution of Psychotherapy

Psychotherapy was primarily the domain of psychiatry until WWII

Psychiatrists unable to meet the clinical needs of veterans

- VA began funding training programs in clinical psychology and hiring clinical psychologists in 1946

Psychologists began to take on expanded clinical responsibilities

Conference establishing the Scientist-Practitioner Model (Boulder Model) in 1949

- Established Ph.D. as the terminal degree

- Emphasized both science/research and clinical practice skills in training

Increase in psychologists doing psychotherapy duringafter WWII lead the conference.

Hans Eysenck (1952) published review critical of psychotherapy outcome research

Concluded that most people do not improve (problematic methodology)

Eysenck’s work led to decades of research on psychotherapy outcomes

- Development of formal treatment manuals

- Randomized Controlled Trials (RCTs) to evaluate interventions

Many effective interventions have been developed and evaluated through RCTs and other rigorous methods

Research-supported: Empirically Supported Treatment (EST) / Evidence-Based Treatment (EBT) Movement (early 1990s)

- APA Task Force report - criteria to be met

- Published Lists of ESTs and Approved Manuals

Current focus: Dissemination of effective treatments

- Increased emphasis on training using a Clinical Science Model

- Efforts to ensure that practitioners are aware of effective interventions