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CLINICAL PYSCHOLOGY INTRODUCTION AND HISTORY, Lecture notes of Clinical Psychology

University of MadrasClinical Psychology

An introduction to clinical pyschology and short description of the history of clinical pyschology

Typology: Lecture notes

2018/2019

Uploaded on 07/31/2019

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UNIT – 1 INTRODUCTION TO CLINICAL PSYCHOLOGY
DEFINITION
• The field of clinical psychology integrates science, theory, and practice to understand,
predict, and alleviate maladjustments, disability and discomfort as well as to promote
human adaptation, adjustments and personal developments. (Society of clinical
psychology 2002)
• Clinical psychology focuses on the intellectual, emotional, biological, psychological,
social , behavioural, aspects of human functioning across the life span, in varying
cultures and at all socio economic levels.
HISTORICAL BACKGROUND
•LIGHTNER WITMER founded the first clinic at the university of Pennsylvania in 1896
–Birth of clinical psychology.
• BABYLONIANS and HEBREWS attempted to treat Mental illness in 2100 B.C
• Through religious perspective like
1. Prayers
2. Wearing of amulets
3. Religious rituals were used
• HEBREWS interpreted dreams as expressions of unacceptable wishes.
• Greeks – HIPPOCRATES -4 HUMORS
- Black Bile
- Yellow bile
- Blood
- Phlegm
• According to Hippocrates, psychopathology resulted from imbalances in one or more
of the four Humors. Excess bile can lead to Melancholy (Depression)
•Phrenitis :High Fever where a person talks Nonsense
•Hysteria (uterus): vague or difficult to understand bodily symptoms in women
•Paranoia: Bizarre Behaviour in the absence of fever.
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UNIT – 1 INTRODUCTION TO CLINICAL PSYCHOLOGY

DEFINITION

  • The field of clinical psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustments, disability and discomfort as well as to promote human adaptation, adjustments and personal developments. (Society of clinical psychology 2002)
  • Clinical psychology focuses on the intellectual, emotional, biological, psychological, social , behavioural, aspects of human functioning across the life span, in varying cultures and at all socio economic levels.

HISTORICAL BACKGROUND

  • (^) LIGHTNER WITMER founded the first clinic at the university of Pennsylvania in 1896 –Birth of clinical psychology.
  • BABYLONIANS and HEBREWS attempted to treat Mental illness in 2100 B.C
  • Through religious perspective like
  1. Prayers
  2. Wearing of amulets
  3. Religious rituals were used
  • HEBREWS interpreted dreams as expressions of unacceptable wishes.
  • Greeks – HIPPOCRATES -4 HUMORS
  • Black Bile
  • Yellow bile
  • Blood
  • Phlegm
  • According to Hippocrates, psychopathology resulted from imbalances in one or more of the four Humors. Excess bile can lead to Melancholy (Depression)
  • Phrenitis :High Fever where a person talks Nonsense
  • Hysteria ( uterus) : vague or difficult to understand bodily symptoms in women
  • Paranoia : Bizarre Behaviour in the absence of fever.
  • Greek philosophers like PLATO (428-347 B.C) believed SOUL HAS THREE STAGES

ALOGISTIKON

SOUL

LOGISTIKON THUMOS

  • SOCRATES (470-39 B.C) All questions lay inside the individual he wrote about healing powers of speaking and self –expression.
  • ARISTOTLE (384-323 B.C) believed in the healing power of words spoken by patient with mental illness.
  • (^) CHINESE believed that imbalance of “YIN” and “YANG” creates mental disorders.
  • As its mentioned in the yellow emperors book of internal Medicine it also includes Acupuncture.
  • Chinese also designed some mental test to recruit civil servants Thousand Years Prior to Europe and USA.
  • In Europe during dark age the link to ancient writing and modern discipline was broken.
  • Psychopathology was understood as the product of demonic possession.
  • Malleus Malificarum (the witches hammer) – Illustration of medieval Zeitgeist.
  • Renaissance brought more change and it was more of humanistic approach in treating the people with mental disorders.
  • Paracelsus and John Weyer these two men rejected spiritual causes of psychological and emotional difficulties.
  • Paracelsus introduced a completely biological approach to mental illness. He practised form of medicine that was similar to what we might call as homeopathy.
  • In the 19th century numerous institutions in the United States where employing moral treatment
  • However within 20 years most Institutions had abandoned and the tenets of moral treatment and had evolved into custodial Institutions for housing the chronically mentally ill
  • The lack of zeal and conviction in the institution super indent and psychiatrist compared to the moral treatment reformers.

MEASUREMENT OF INDIVIDUAL DIFFERENCES

  • One of the important figures in the early history of psychological testing was sir Francis Galton (1822 - 1911)
  • Galton was greatly influenced by the book written by his cousin Charles Darwin the origin of species.
  • Galton was more interested in in measuring the individual differences.
  • James McKeen Cattell (1862 -1944) was inspired by Galton.
  • In the year 1890 Cattell w as the first one to use the term “ mental test” in his article.
  • Cattell laid down some of the important principles of psychological testing.
  • Cattell’s work foreshadowed the methods for developing standardized tests Intelligence. EMERGENCE OF SCIENTIFIC PSYCHIATRY
  • During the 19th Century there was a growing faith in Science and the scientific method.
  • The 19th Century saw the Initial identification naming and detailed description of several major psychiatric conditions
  • J. Langdon Down described the syndrome involving mental retardation and it continues to bear his name
  • Ewald Hecker published a monograph on Hebephrenia
  • Emil Kraepelin (1855 – 1926) who published the first edition of a textbook on psychiatry in 1883.
  • In the textbook he has given a detailed description of Dementia Praecox a syndrome marked by hallucinations delusions progressive deterioration in intellectual functioning and incongruent mood expressions.
  • In later editions he also describe subtypes of the condition including paranoid ,hebephrenia and catatonic
  • Dementia praecox is what we would now call Schizophrenia

KRAEPELIN

DEMENTIA PRAECOX MANIC DEPRESSIVE ILLNESS

ENDOGENOUS EXOGENOUS

  • The emergence of scientific psychiatry helped set the stage of clinical psychology in a variety of ways.
  • First improved classification created a need for improved methods of making diagnosis.
    • Assessment as one of the cornerstone activities of clinical psychology.
    • Second the differentiation of mental retardation from other psychiatric conditions created and need for valid instruments for assessing intellectual functioning.
    • Third psychiatry classification systems most notably Kraeplin identified some psychiatric conditions that may have non biological causes.
    • The most important psychiatric syndrome of for which non biological causes were considered was hysteria.
    • (^) Hysteria referred to a condition in which patients presented with Vague unusual medical complaints many of which appear to be neurological for which no physical basis could be identified patients with hysteria.
    • Usually adolescent are young adult females have such problems is anxiety fatigue memory loss anaesthesia loss of feeling including sensory impairment or paralyzes
  • In 1889 he co-founded the first psychological laboratory in France as well as the first French journal of psychology Binet and Simon introduced mental age as the score of their scale in 1908.
  • Binet and Simon developed a classification system for children based upon their performance on the scale they classified the children into
  1. An idiot - 2yrs and lower
  2. Imbecile - 3-7yrs
  3. Moron - above 7yrs of MA
  • The Binet - Simon scale was quickly adopted by researchers and conditions interested in Intelligence and the classification of defective children
  • He developed the norm referenced test for intelligence
  • Binet’s tasks measured complex intellectual process such as judgement problem solving abstract thinking and memory
  • (^) Whereas Cattell's mental test measured only sensory and motor functioning
  • Henry Goddard (1886 – 1957) he was the director Institute of backward children vineland.
  • The term moron was coined by him and he also published English version of Binet -Simon scale in 1911.

BINET’S CONTRIBUTIONS TO FIELD OF CLINICAL PSYCHOLOGY

  • Binet -Simon scale was the four runners of modern test of Intelligence
  • Second his development of the mental age Concept foreshadowed the creation of the intellectual quotient
  • Third being a was an early example of What would later to be called as a scientist – practitioner.
  • Finally the success of Binet’s scale was the key factor in initiating a boom in psychological testing
  • APA - American Psychological Association was established in 1892

CHILDHOOD : WORLD WAR 1 THROUGH WORLD WAR II

ASSESSMENTS:

  • Alpha Army -verbal scale
  • Army beta -nonverbal test of Intelligence
  • Lewis Terman revised and published Stanford Binet scale 1916
  • Wechsler Bellvue was one of the first individually administered intelligence test developed for use with adults.
  • Advances in psychological testing where not limited to the arena of intellectual assessment in the period between the world wars psychologists wear also devoting their attention to developing test for measuring personality and diagnosing mental disorders.
  • In 1917 Robert Woods Worth created the first test for detecting mental disturbance is called the Psycho Neurotic Inventory and it was labelled the personal data sheet so that the soldiers completing it would not be alarmed the test served well as a screening instrument for identifying recruits suffering with various mental condition
  • In 1921 Hermann Rorschach (1884 – 1922) published Psychodiagnostik in which he described the method of diagnosing patients and characterizing features of their personality based upon their responses to a set of 10 inkblots.
  • The thematic apperception test (TAT) is probably the best known projective test of personality.
  • It was developed by Henry Murray in the year 1938.
  • In 1943 MMPI was developed.
  • World War II again triggered growth spurt in psychological testing used in selection of Naval officers Pilots submarine personal and spies.
  • The recently developed MMPI, Wechsler Bellvue and Rorschach were used extensively during the war and the identification of clinical psychology with these test grow stronger.

THEORY

  • The dominant theory in psychiatry and Clinical Psychology at this point in history was clearly Psycho Analysis.
  • In the 1920 and 1930 Psychoanalysis had its direct impact upon the developing field of clinical psychology through its influence upon psychological testing although

ADULTHOOD: MILESTONES AND GROWING PAINS

TRAINING

  • In 1976 Psy. D programs where accepted in the place of traditional Ph. D
  • Training master level programs where not recommended initially and was not allowed to call themselves as psychologist.
  • In the Vail conference it was proposed that master level training should qualify individuals to use the title “ psychologist. ”

PSYCHOTHERAPY

  • Psychoanalytic and Psychoanalysis where dominant.
  • (^) Client - centred approach By Carl Rogers (1902-1987) he focused more on self actualization he initiated a whole new era of psychotherapy research.
  • Joseph Wolpe was a behaviour therapy trial blazer.
  • Wolpe proposed the concept of Reciprocal Inhibition as a principle of behaviour change that relied upon countering and anxiety by competing feelings state.
  • Wolpe developed the psychotherapy techniques Systematic Desensitization based upon the principle of reciprocal inhibition
  • In addition to Wolpe other pioneers of the behaviour therapy movement included Hans Eysenck B.F. Skinner
  • B.F. Skinner is known for his principles of operant conditioning
  • Behaviour therapy has slowly expanded and cognitive behaviour therapy evolved the two most influential early development every developers of cognitive behaviour therapy by Albert Ellis and Aaron Beck.
  • Cognitive behaviour therapy has steadily grown in popularity since it was first described almost 50 years ago
  • Contemporary clinical psychologist focus is more on psychotherapy.

PSYCHOLOGICAL ASSESSMENTS

  • In 1960 the reliability of test like TAT and RORSCHACH what's questions and criticized
  • The testing enterprise has improved in a variety of ways
  1. The standards for normative data have increased substantially in addition to representativeness and normal sampling.
  2. Contemporary psychological test strive to be inclusive in item content as well
  3. Perhaps one of the most significant consequences of the critical attention way to test of Intelligence and personality has been the proliferation of specific emotions
  • Perhaps one of the most significant consequences of the critical attention way to test of Intelligence and personality has been the proliferation of specific emotions personal characteristics in cognitive skills reading academic achievement and many other attributes have been developed
  1. Popular tests are periodically revised and the new additions attempt to address the problems identified in the earlier versions.
  2. Finally test developers have take some steps to minimise the misuse of psychological test data

PROFESSIONAL PRACTICE

  • Professional practice licensing American Medical Association opposed licensing to clinical psychologist to prevent clinical psychologist practicing psychotherapy privately.
  • But clinical psychologists fought and won the battle.
  • In India rehabilitation Council of India gives the licence to clinical psychologist.
  • Managed care seems to be a biggest problem in United States due to increased paperwork.

CHARACTERISTICS OF CLINICAL PSYCHOLOGY

  1. Emphasis on Science
  2. Emphasis on Maladjustments
  3. Emphasis on Individual
  4. Emphasis on Helping

EMPHASIS ON SCIENCE DETERMINISM CLINICAL PSYCHOLOGY EMPIRICISM

TEACHING

  • 15 to 20% are employed as professors at colleges and Universities.
  • They teach abnormal psychology test of measurements, introduction to Clinical Psychology, psychotherapy, neuropsychology, gero psychology, theories of psychopathology and health psychology.
  • They help students to develop clinical skills in assessments therapy and consultation they also do clinical supervision / internships.

PSYCHOTHERAPY

  • Psychotherapy - helping people to understand and resolve problems.
  • The term psychotherapy encompasses abroad array of psychological interventions including behaviour modification, individual counseling ,family counselling and parent training.
  • Clinical psychologist take up therapies for individuals couples groups etc.,
  • Psychotherapy has become the predominant activity of clinical psychologist 84% of clinical psychologist engage in psychotherapy.

ASSESSMENTS

  • It's one of the frequently engaged activities of clinical psychologist.
  • It involves collecting information about people's behaviour interest emotions thoughts intelligence interpersonal styles and so on.
  • Integrating this information to develop a greater understanding of the person’s psychological condition. Assessments
  • Are to diagnose
  • Formulate treatment plants
  • To make predictions about future behaviour
  • Evaluate the outcome of a psychological treatment on intervention

CONSULTATION

  • Clinical psychologist utilise skills in teaching research assessment or even psychotherapy.
  • Clinical psychologist are often hired by organisations to provide advise and share their expertise they work in places like schools , oncology department, business settings, law enforcement agencies mental health agencies and clinics general hospitals military etc.,

ADMINISTRATION

  • Clinical psychologist’s have good organisation skills and good interpersonal skills so they are even successful on their administrative work.
  • It is unusual that a clinical psychologist to spend all his or her life in one professional activities.
  • Variety is the norm.

DISTINGUISHING CLINICAL PSYCHOLOGY FROM RELATED PROFESSIONS:

PSYCHIATRY:

  • Common difference in psychiatry day prescribe medicines psychologist don't
  • But a New Mexico psychologist are allowed to prescribe medicines with appropriate training
  • So basically psychiatry is a medical speciality they do their MBBS and then MD
  • Clinical psychologist generally do there under graduation post graduation and then M Phil and PhD training psychiatrist learn about biochemistry anatomy and physiology
  • Where are psychologist learn about theories how to critically evaluate and research doctors takes hippocratic oath psychologist defend their thesis
  • Psychiatrist is strongly dominated by biological model of human behaviour both make diagnosis but psychologist do assessments psychotherapy is again carried out by both of them

COUNSELLING PSYCHOLOGY