Introduction to Clinical Psychology



Introduction to Clinical Psychology

Clinical psychology is relatively new ……Why?

• Titchner and others saw mental health to be outside of what psychology was to study.

• Conflict between the medical model and psychological model of mental health.

• Medical model – there are naturally occurring causes for all illnesses including mental illness

Emil Kraepelin

• Studied with Wundt but attempted to classify mental illnesses according to what caused them, their symptoms, and their treatment – 1883.

• Mania.

• Depression.

• Dementia praecox.

• Manic depression.

• Neurosis – mild disorders.

• Most disorders were not curable and caused by biological factors.

Psychological Model

Lightner Witmer:

• 1897 – founded the first psychological clinic.

• 1907 – developed the first clinical journal The Psychological Clinic.

• He was trained as a scientist, and believed that clinicians should be trained as scientist and apply psychological science to treatment of mental illness.

• Psychological model would not become extensively accepted until Freud, an M.D. adopted a non-medical model of mental illness.

• WWII also gave impetus because there was no enough psychiatrists to treat the large numbers of people needing mental health services.

History of clinical psychology

• Treating and counseling patients a very recent profession

• Mental illness always considered part of medicine

• No doctoral programs in clinical psychology before WWII.

Early history

• Basic issue : no outward signs of injury or illness – strange or bizarre behavior with no visible cause.

• Trephination – cutting holes in the skull to let evil spirits out.

• Primitive cultures used other supernatural cures.

• Early Greeks performed ceremonies to please the gods so they would leave the individual alone.

• Greek and Roman physicians removed mysticism(الروحانيات او التصوف) from medicine and looked for physical causes.

• Decline of Greek and Roman civilizations resulted in a return to mythology and demonology.

• Exorcism of evil spirits returned.

Middle ages and mental illness

• The dominant Christian church concerned about the contention between God and the devil for people’s souls.

• Since no cause could be seen for mental illness, voluntary possession by the devil was proposed as the cause.

This solution solved two problems

• People feared he mentally ill for two reasons:

1. Their strange behavior scared people

2. People were scared they could develop these bizarre behaviors

• Solution became, these people voluntarily consorted with he devil; I do not.

• They need to be executed so they won’t hurt others.

•

“Treatment” of mentally ill

• Get the people to confess their sins of consorting with the devil. They have to confess so use torture.

• After getting a confession, execute them for their sins.

Treatment in 18th and 19th century not much better

• Us of large institutions or asylums to housed mentally ill; emphasis was on protecting the public not to treating the mentally ill.

• Institutions largely paid for by allowing tourist to pay to walk through the asylum and watch the crazy people.

Tools

• Starvation and tormenting

• Water cures

• Whirling

• Bloodletting – most prevalent

The return to mental illness having natural causes

• 1790’s Paris.

• Philippe Pinel – changed the treatment of people in the major asylum in Paris.

• Pinel not the first to remove chains from patients it had happened, din Italy 8 years earlier.

• Pinel instituted many of the basic medical philosophies to mental health.

Philosophy Of Pinel

• Do no harm – ended bloodletting, whirling, etc.

• Use minimal restraint necessary – least restrictive environment needed to maintain safety and order.

• Provide humane conditions.

• Eliminate physical abuse

• These people are sick not criminals

• Most important for psychology – not all illnesses had biological causes

Treatment in Britain and the U.S.

• Tukes and others were successful in developing small private institutions in Britain.

• Dorthea Dix and others successful in reforming many institutions in the U.S.

• Most large institutions tended to emphasize protecting the public at the expense of treatment.

• Greatest change in treatment has resulted from the development of psychoactive drugs.

Foundations of psychoanalysis

• Franz Mesmer – passed magnets over people until they fell into a trance – called mesmerized.

• He attributed his cure as the flow of healing energy from

a healthy person

to an unhealthy person.

• 1784 – A Royal Commission ruled mesmerism useless and dangerous and banned Mesmer from Paris.

Mesmerism and hypnosis

• British proponents were able to show that some surgical procedures could be performed on mesmerized people.

• 1843 James Braid a British physician discovered that mesmerism was a form of deep sleep induced by suggestion which he called hypnotism.

Sigmund Freud (1856-1939)

• 1887 Sigmund Freud develops free association

and related “talking” cures.

• Beginnings of psycho-analytic “approach”.

• Personality theory.

Freud and Joseph Breuer

• Treatment of Anna O a women suffering from hysteria.

• Reportedly Breuer cured her of hysteria through hypnosis and having her relive the experiences that led to her symptoms – a cathartic cure.

Freud and psychoanalytic theory

• Freud abandoned hypnosis for free association.

• Patients spoke about whatever came into their mind.

• His patients – mostly neurotic women- spoke about sexual seductions by their fathers.

Two basic conclusions of Freud

• Infantile sexuality was a reality.

• When patients recall sexual memories from early childhood, the unconscious does not differentiate between truth and “emotionally charged fiction”.

• Treatment needed to help patients distinguish between psychic reality and actual reality.

Carl Jung (1875-1961)

• Jung, Carl G. (1910). The association method. American Journal of Psychology, 31,219-269.

Important contributions:

• Introversion-extraversion

• Archetypes in collective unconscious

• Founder of Analytical Psychology

Extraversion is "the act, state, or habit of being predominantly concerned with and obtaining gratification from what is outside the self"Extraverts tend to enjoy human interactions and to be enthusiastic, talkative, assertive, and gregarious. They take pleasure in activities that involve large social gatherings, such as parties, community activities.

Introversion is "the state of or tendency toward being wholly or predominantly concerned with and interested in one's own mental life“ Introverts tend to be more reserved and less outspoken in large groups. They often take pleasure in solitary activities such as reading, writing, drawing, and using computers.

An archetype is an unlearned tendency to experience things in a certain way.

Rorschach

Swiss psychiatrist Hermann Rorschach (1884-1922) in 1921 described his famous ink-blot projective test

Anna Freud

• Anna Freud (1895-1982) published The ego and the mechanisms of defense in 1936.

• Began child psychoanalysis.

Erik Erikson (1902-1994)

• Identity.

• Adult stages of development.

• Epigenetic principle:- There Is A Natural, Predetermined

Order To Development.

THE STAGES of Er.Er.

8. Integrity vs. Despair

7. Generativity vs. Stagnation Adult stage

6. Intimacy vs. Isolation

5. Identity vs. Role Confusion (Diffusion)

4. Industry vs. Inferiority

3. Initiative vs. Guilt

2. Autonomy vs. Shame

1. Trust vs. Mistrust

The roots of clinical psychology

• Prewar years when its appear in embryonic form(Reisman,1976; Resnick, 1997; Routh, 1994).

• Three sets of social and historical; factor initially shaped the filed and continue to influence it:

1. The use of scientific research methods in psychology.

2. Study of human individual differences.

3. Change in how behavior disorder have been viewed and treated over the years.

The Birth of clinical psychology 1896-1917

• By the end of 19th century, the ground hade been prepared for its appearance as discipline that:-

1. Psychology had emerged as a science.

2. Psychologist start applying scientific methods to study individual differences.

3. fraud's dynamics approach to behavior disorder was about to open vast new areas of inquiry for psychologists interested in understanding deviance.

Lightner Witmer (1867-1956)

• In march 1986 student “Charles Gilman” student

was referred by her teacher to be helped to Lightner

Witmer, She describe her student as “chronic bad speller”,

Witmer “ took the case” thus becoming the first clinical psychologist.

• Witmer approach was to assess Charles's problem and then arrange for appropriate remedial procedure.

What is Clinical Psychology

• The field of Clinical Psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, and personal development.

• Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the lifespan, in varying cultures, and at all economic levels.

Definetion Diagnose or evaluates mental and emotional disorders of individuals through observation, interview, and psychological tests, and formulate and administer programs of treatment.

Clinical Psychology Profession

• Clinical psychology is sub area of psychology whose member, like some others psychologist, generate research about human behavior, seek to apply the results of that research, and engage in individual assessment. And like the member of some other profession, clinical psychology provide assistance to those who need help with psychological problem.

Distinguish clinical psychology from other branch of psychology

• The most notable distinguish feature has been called the clinical attitude or clinical approach ( korchin 1976).

Training

• 3-year undergraduate degree in Psychology (minimum 2:1 honours degree).

• Healthcare-related experience, e.g. assistant psychologist, clinical research (1-year+).

• 3-year postgraduate clinical training(Doctor of Clinical Psychology - ClinPsyD).

Clinical Psychology….

……….Is not limited to therapy and assessment:

• assessment

• therapies

• Research.

• Consultation.

• Treatment.

• Administration.

Role of Clinical Psychologist

• Assessment and diagnosis of individual, system or service problems

• Treatment using psychologically based techniques

• Evaluation of the outcomes of clinical intervention

• Consultation with other health professional to support them in their client work.

• Teaching and training of (i) psychologists and (ii) other health professionals

• Research including service evaluation.

• Contributing to policy development and service planning.

• Participation in the design and implementation of health promotion / prevention strategies.

• Management of services both directly and through participation in supervisory boards / committees.

• Supervision of both psychologists and other health professionals.

• Participation in investigation / inquiry processes.

• Provision of expert opinion for the courts and other quasi-judicial processes.

Clinical Psychology: General Characteristic

Emphasizes:

• Science

• Maladjustment

• Individual

Emphasis on Science

Clinical psychology, as a sub discipline within the science psychology, adheres to two important assumptions of science:

• Determinism-events have determinable causes

• Empiricism-events must be observable and measurable

Emphasis on Maladjustment

• The concern is with the scientific understanding of abnormal behavior and emotional suffering

Emphasis on the Individual

• Clinical psychology uses research information gathered in groups of people to guide their work with individuals

Range of care groups

• Infants, children and their families with developmental, emotional, intellectual & physical disabilities and problems.

• Adolescents with a wide range of difficulties from adjustment problems to serious mental disorder.

• Adults with mental health problems ranging from anxiety, depression and major mental disorder.

• Families and couples with significant relationship difficulties.

• Adults with learning, physical and sensory disabilities.

• Older adults and their carers.

• Victims of sexual and other abuse- both child and adult

• Refugees and asylum seekers.

• Emergency response to people exposed to traumatic events.

• Social groups with identified high health risks e.g. young single mothers, and substance abusers.

Client and their problem

• Clinical psychologists work on almost any kind of human behavioral problem.

• Survey on 6,500 clinicians, most commonly treated problem are anxiety, depression, difficulties in interpersonal relationships, marital problem, schools difficulties, psychosomatic and physical symptoms, jobs related difficulties, alcoholism, or other form of drugs abuse, psychosis and mental retardation. (vandenBos& stapp,1983).

• To deal with all these problem clinical psychologist not being work alone they work with in comprehensive team, because client complain often complex and frequently stem from combination of biological, social factor, these team compose of psychiatrist, social worker, specialized testing, mediation, or other service.

Working Lives of Clinical Psychologists

• Work Settings

• Agencies

• Private Practice

• Work Schedules

• Clinicians

• Academics

Employment settings and salaries for clinical psychologists

• Most clinical psychology work in single of facility:- child clinic, guidance center, college, university, psychological department, school, public and privet medical and psychiatric hospital, etc.

salaries

• Doctoral level ranged from 46,000 to 80,000.

• At college 41,000 for assistance professors

• 72,000 for full professors.

The challenge of cultural diversity

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