Recent History of Clinical Psychology. Influence of WWII 9/11/2009. As in WWI, psychologists were called upon to evaluate soldiers

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1 Recent History of Clinical Psychology Influence of WWII As in WWI, psychologists were called upon to evaluate soldiers Intellectual, psychiatric, and personality assessments were given to over 20 million people Army General Classification Test, Personal Inventory, Rorschach, TAT Also called upon to perform therapy and consultation Influence of WWII In addition to the war effort, many other developments during this time MMPI developed by Hathaway in 43, WISC by Wechsler in 49 Connecticut passes certification law in 45, followed by many other states ABEPP created in 46, develops EPPP 1

2 Post WWII Over 40K veterans were hospitalized in VAs for psych reasons Psychiatrists were overwhelmed, needed more CPs for testing, therapy, consultation, and research VA teamed with major universities to develop formal CP training programs in 46 Over 200 students in 22 programs later that year VA and CP VAs offered good salary, secure positions, and many options for service By 1950s, single largest employer of CPs Still a tension between academic psychologists and those in applied fields Training NIMH recognized need for MH practitioners, developed grant programs to train CPs David Shakow and the APA Committee on Training in Clinical Psychology developed formal training guidelines in 1947 Four years of doctoral study 1 year clinical internship Course content Training to be scientists and clinicians 2

3 Training In 48, APA began to evaluate training programs using these guidelines, accrediting those that met certain criteria This accreditation was crucial, as federal monies were given to support such programs Led to a committee meeting in Boulder, Colorado in 1949 The Boulder Conference Co sponsored by the VA and NIMH Formally adopted the scientist practitioner model of training Emphasized training in both conducting research and performing clinical services Decreed that a PhD from university based training program + 1 year of clinical internship were minimum preparation needed The Boulder Conference Met for two weeks, 73 participants S P model became accepted and predominant training approach Rise from 22 to 42 APA accredited schools between

4 Post Boulder Critiques abounded, particularly about emphasis on conducting research Only 10% of CPs published research, so why spend so much energy on it? No resolution, although free standing PsyD programs now offer much less researchfocused training Rise of Alternative Therapies First half of 20 th century was dominated by Freudian therapy and it s derivatives As CPs became more involved in doing therapy, new approaches were developed Rise of psychoactive medications also greatly altered therapy Behavioral Approach Applies theories of learning and condition to treatment of problems Rooted in basic science conducted by Pavlov, Watson, Thorndike, Hull, Dollard, Miller, and Skinner BT began as a reaction to disappointment with psychodynamic and medical results Eysenck s 1952 article 4

5 Behavioral Approach BT appealed to research oriented clinicians Operationalized easily Measurement was possible Statistical analysis Joseph Wolpe in South Africa, Eysenck & Shapiro in UK, Lindsley and Lovass in US Embraced by those following the Boulder model of training Behavioral Approach Various approaches, but all have commonalities Problematic behavior is learned and can be altered via learning principles Treatment is based on scientifically derived principles Collaborative relationship with client Association for Advancement of Behavior Therapy was founded in 1967 Cognitive Behavioral Approach Limits of a strict focus on overt behavior led to focus on impact on thinking and attitudes on behavior in 1970s Ellis REBT Beck s cognitive therapy for depression Mahoney s cognitive restructuring Meichenbaum s stress inoculation Bandura s social learning 5

6 Cognitive Behavioral Approach Focused on integrating behavioral and cognitive approaches Changing thoughts, feelings, and expectations became as important as overt behavior Commonalities include Learning and behavior are mediated by cognitive processes Therapist helps alter maladaptive cognitions Led to AABT becoming the Association for Behavioral and Cognitive Therapies in 2005 Humanistic Approach Also arose in frustration at PD and BT approach, delivered a more optimistic view of humans and their potential for growth/change Strongly influenced by the philosophy of existentialism (Kerkegaard, Nietzsche, Sarte) There is a basic human need to seek and define meaning in life Humanistic Approach Leading figures were Carl Rogers, Maslow, Perls, and Frankl Commonalities included Commonalities included Commitment to phenomological model, emphasizing self determination and freedom Humans strive for growth Belief in free will Person centered, respectful of client 6

7 Family Systems Approach Focused on treatment of the entire family rather than an individual It s the whole system that needs to be changed, not one individual Began as a study on communication by Bateson (anthropologist), Haley (comm. Expert), Weakland (engineer), and Jackson (psychiatrist) in the 50s Family Systems Approach Major figures were Haley, Minuchin, Bowen, Ackerman Alldifferent FS approaches focused on communication and relationships within the family, as well as the role of system in maintaining problems Psychotropic Medication Accidental discovery of medications for severe psychological problems in the 50s Cade giving lithium chloride to guinea pigs Deniker & Delay s Thorazine to schizophrenics Benzodiazepines in the 60s for anxiety reduction Very positive reaction from lay community, even after side effects and limitations were realized 7

8 Psychotropic Medication Meds allowed number of inpatients to be reduced from 500,000 to 50,000 between 1950 and 2000 Gave a new role to psychiatrists, emphasized brain/body connection Today, between 20 30% of all meds prescribed are psychotropics Community Mental Health With the end of warehousing and deinstitutionalization, many patients needed affordable outpatient services Huge government support for CMH clinics at first, but by the mid 1980s lots of support was removed Integrative Approaches During 70s and 80s, many psychologists began emphasizing the common factors between different clinical approaches Wachtel, Frank, and others tried to incorporate different aspects of therapies into one approach 8

9 Biopsychosocial Approach Research demonstrating that biological, sociological, and psychological factors were all at play in most illness, including mental, led to anemphasis on the BSP approach Became foundation for health psychology, and very influential on all areas of clinical psych A New Training Model In 1973 a conference was in Vail, Colorado that defined a new, different model of training The scholar practitioner model was endorsed as an alternative to the scientist practitioner Emphasizes delivery of services, minimizing research training Also endorsed free standing schools as an alternative to university programs and the PsyD degree A New Training Model Vail model has become hugely popular, outnumbers Boulder model 4:1 Vail conference also endorsed terminal Vail conference also endorsed terminal master s recipients as professional psychologists APA did not endorse this, stated a doctorate was required still law in most states 9

10 Today Numerous challenges and difficulties for modern clinical psychology Increasing diversity of the US Lack of diversity among CPs Lack of diversity among CPs Influx of professional school trained CPs Reductions in federal funding Changes in reimbursement for services 10