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Lecture Preview Clinical Psychology Immediately after World War II The Rise of Alternatives to the Psychodynamic Approach A New Training Model Emerges:

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Presentation on theme: "Lecture Preview Clinical Psychology Immediately after World War II The Rise of Alternatives to the Psychodynamic Approach A New Training Model Emerges:"— Presentation transcript:

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3 Lecture Preview Clinical Psychology Immediately after World War II The Rise of Alternatives to the Psychodynamic Approach A New Training Model Emerges: The Vail Model and Professional Schools of Psychology

4 Clinical Psychology Immediately after World War II Following the war, over 40,000 veterans were hospitalized. Psychiatrists were unable to meet the treatment demands of these huge numbers of veterans. It resulted in increase in the number of clinical psychologists. Veteran’s Administration hospitals became the largest single employer of clinical psychologists in the USA.

5 Many others preferred to focus on the science of psychology in academic environments. There was a division between science and practice from the beginning.

6 Training The APA Committee on Training in Clinical Psychology recommended that training be comprehensive in research, treatment, and assessment. In 1948, the APA began to carefully evaluate and accredit doctoral training programs. Psychology departments in universities across the USA had a freedom to determine their training programs.

7 The Boulder Conference Prior to 1949, psychology departments in universities across the country had a great deal of freedom to determine how they should run their training programs. The Boulder Conference was called (convened) in It was the first national meeting to discuss standards for doctoral training.

8 The Boulder Conference This training model stated that a PhD degree in psychology from a universitybased training program plus a one-year clinical internship were necessary for adequate preparation. The Boulder model became known as the scientist- practitioner model. Clinical psychologists should be competent in both conducting research and providing professional services such as psychotherapy and assessment.

9 Post-Boulder Conference Events Additional conferences convened to discuss the pros and cons of the clinical psychology training model. The growth of clinical psychology during the 1950s was enormous. APA membership more than doubled during the 1950s.

10 Post-Boulder Conference Events In 1952, American Psychiatric Association published diagnostic categories in Diagnostic and Statistical Manual (DSM - I). In 1953, the first attempt to outline ethical principles for psychologists was published by the APA.

11 The Rise of Alternatives to the Psychodynamic Approach During the first half of the 20 th century, the psychoanalytic approach founded by Freud and the behavioral conditioning approach founded by John Watson.

12 The Rise of Alternatives to the Psychodynamic Approach During the 1950s, 1960s, and 1970s, many new approaches were developed as alternatives to the traditional psychodynamic approach: humanistic, behavioral, cognitive-behavioral, and family systems approaches

13 The Rise of Alternatives to the Psychodynamic Approach In the 1960s, the community mental health movement rose. Psychotropic medication in treating mental illness introduced. These two events had powerful influences on clinical psychology.

14 The Behavioral Approach The behavioral approach applies theories of learning and conditioning to the understanding of human behavior and the treatment of problems. It had its roots in the conditioning research of Ivan Pavlov in Russia. The behaviorism and learning theory in the USA conducted by John Watson, Edward Thorndike, Clark Hull, John Dollard, Neal Miller, and B. F. Skinner.

15 The Behavioral Approach Behaviorism became an attractive alternative to medical and psychodynamic strategies during the 1950s and 1960s. Some research-oriented clinicians felt that behavior therapy proved more effective in empirical research trials relative to traditional theories and methods such as psychoanalysis.

16 The Behavioral Approach The behavioral approach was viewed by many as more scientifically based than the psychodynamic approach. Behavioral techniques were more readily operationalized to allow for research and statistical analysis. It was easier to measure a person had a panic attack than measuring constructs such as the id, transference, or unconscious conflicts.

17 Pavlov (1849–1936)

18 The Behavioral Approach Behavior therapy approaches to treatment were developed in South Africa by Joseph Wolpe ( ). He developed systematic desensitization to treat phobias.

19 The Behavioral Approach Behavior therapy was well suited to the Boulder model because clinical psychology training was designed to emphasize both the science and practice. The behavioral approach was well suited to the social and political influences of the time. It was an optimistic notion that we could create a more perfect society using social engineering and conditioning techniques.

20 The Behavioral Approach There are various types of behavior therapy such as applied behavioral analysis, social learning theory-based treatment of Bandura and CBT. Their commonality is that most problematic behavior is learned and can be altered through the use of learning principles. Treatment methods are scientifically based procedures and can be objectively used and evaluated.

21 The Cognitive-Behavioral Approach became popular during the 1970s. Many behavioral researchers and clinicians admitted a number of significant limitations in their model. The approach ignored the contributions of thinking and attitudes in human behavior.

22 The Cognitive-Behavioral Approach Albert Ellis’s Rational-Emotive Therapy; Aaron Beck’s cognitive treatments for depression; the cognitive restructuring work of M. Mahoney; the stress inoculation work of Meichenbaum; the self-efficacy work of Bandura led the integration cognitive approaches with behavioral approaches.

23 Aaron Beck (1921- )

24 The Cognitive-Behavioral Approach Ellis’ REBT focuses on to alter the patient’s irrational beliefs about themselves and others. Beck’s cognitive approach focuses on to alter maladaptive thought patterns and developing more adaptive ways of thinking. Depressed people tend to view themselves, others, and the world as more negative. Meichenbaum’s self-instructional approach uses self-talk to alter problematic thinking and behavior..

25 Their commonalities are that learning and behavior are cognitively mediated by attitudes and attributions. that the role of the therapist is to serve as a coach and educator in assisting the alteration of maladaptive cognitive processes and behavior.

26 The Humanistic Approach employed philosophy, existentialism, and theories of human growth and potential. It focused on the patient’s experience or phenomenology. It offered warmth, empathy, and unconditional positive regard in psychotherapeutic interactions.

27 The Humanistic Approach During the 1950s and 1960s, the humanistic approach gained common acceptance. Psychodynamic and behavioral views perceived the human nature as negative. The humanistic school accepted the more optimistic and approval views. The humanistic approach became known as the third force following the psychodynamic and behavioral approaches.

28 The Humanistic Approach It was strongly influenced by philosophy and the existential approach. The existential approach became popular after World War I and in response to Nazi Germany during World War II. Kierkegaard, Nietzsche, Sartre, Buber, and Heidegger were existantialists. This approach focused on the meaning of life.

29 The Humanistic Approach American psychologist Rollo May and psychiatrist Irvin Yalom helped to popularize the existential approach to humanistic therapy in the USA. Psychoanalytic writers such as Hans Kohut and Otto Kernberg have integrated some of the humanistic perspective into their writing. Carl Rogers, Abraham Maslow, Frederick Perls, Victor Frankl contributed to the development of the humanistic approaches to psychotherapy.

30 Their commonalities are that humans are able to be consciously reflective and have the ability to experience self-determination and freedom. Thus, therapists must be able to fully understand a person’s perception. that humans struggle toward growth and are not trying to maintain homeostasis by satisfying various primitive needs and conflicts.

31 Existantialists Sartre Kierkegaard Nietzsche

32 Their commonalities are that defended a belief in free will and regarded human behavior as not just a by-product of early childhood experiences or only conditioned responses to the external environment. that is person-centered with maximum respect for the individual and his or her experiences.

33 Carl Rogers ( ) The client-centered approach of Carl Rogers became the most influential humanistic therapy. The approach emphasizes empathy, unconditional positive regard, congruence, intensive active listening, and support to reach full human potential.

34 The Family Systems Approaches tend to use the whole family in understanding and treating problematic feelings and behavior. Prior to the 1950s, the family members of the identified patient were left out of the treatment and not viewed as potentially active agents of dysfunction and recovery. During the 1950s, 1960s, and 1970s, the family systems approach became popular.

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36 The Family Systems Approaches Therapists observed that patient functioning often worsened when the patient interacted with family members. Therefore, all family members were treated together. The family systems approach emerged from the Bateson Project during the 1950s. Gregory Bateson, an anthropologist, was interested in communication styles, collaborating with Jay Haley to examine communication styles such as double- bind communication. Double-bind messages include impossible-to-satisfy requests.

37 The Family Systems Approaches Jay Haley later joined with Salvador Minuchin to develop the structural family therapy model and focused on family boundaries and generational hierarchies. Haley, in the 1970s, founded the Washington Family Institute where his wife, Cloe Madanes, developed the strategic therapy model. Strategic therapy uses paradoxical intention.

38 In Europe, Maria Selvini-Palazoli and colleagues founded the Milan Associates to treat families confronted with anorexia nervosa in a family member. Murray Bowen used psychoanalytic theory in their application of family therapy.

39 The Family Systems Approaches Carl Whitaker and Virginia Satir focused on experiential models. Nathan Ackerman and Salvador Minuchin developed structural family therapy and focused on family boundaries and generational hierarchies.

40 The Family Systems Approaches While there are various types of family therapies, commonalities are: a focus on the role of the whole family system in producing and maintaining problematic behavior, communication patterns associated with family problems,and ongoing maladaptive relationship patterns among family members. Intervention at the family level rather than at the individual level became the goal of these treatment strategies.

41 Psychotropic Medication Biological treatments and medications such as opium, insulin, and electric convulsive therapy (ECT) were used to treat mental illnesses during the early and mid part of the 20 th century.

42 ECT

43  Clinical Psychology Immediately after World War II  Boulder Conference in 1949, standards for doctoral training, scientist-practitioner model.  Alternative psychotherapies rose to the Psychodynamic Approach

44 Psychotropic Medication In 1950s, the effective medications were developed to treat severe disorders such as SCH and bipolar illness. It was by accident. In 1952, Jean Delay gave the chlorpromazine = Largactil to patients. They found that schizophrenic patients experienced fewer hallucinations and delusions.

45 Psychotropic Medication Benzodiazepines (such as Diazem) were found in the 1960s to be effective in reducing anxiety. The prophylactic use of neuroleptics increased the possibility of community residence and decreased the demand for hospitalization. There was a trend to deinstitutionalize for schizophrenic patients. The increasing use of medication to treat psychiatric problems gave the leadership role physicians.

46 Psychotropic Medication Today, about 20% to 30% of all medications prescribed are related to depr and anx. Psychologists obtained prescription privileges in Louisiana, New Mexico and Guam.

47 Community Mental Health Movement During the period of deinstitutionalization, patients needed outpatient services to adjust to the society, obtain employment, and cope with the stresses of life and social demands. Interest in the prevention of mental illness as well as the social factors that contribute to mental illness— such as poverty, homelessness, racism, unemployment, and divorce— developed community mental health movement.

48 The community mental health clinics opened throughout the USA. Psychologists provide a wide range of professional services in these clinics.

49 The Integrative Approaches After the explosion of new theories and approaches during the 1950s, 1960s, and 1970s, many researchers and clinicians felt dissatisfied with one particular theory. Each school such as behavioral, CBT, humanistic, family systems, psychodynamic developed their own philosophy or worldview.

50 The Integrative Approaches Many psychologists felt dissatisfied with one particular theory. During the late 1970s and early 1980s, many professionals sought to integrate the best. Research was unable to demonstrate that any one treatment approach or theoretical orientation was superior relative to the others. Majority of clinicians identified themselves as being eclectic or integrative.

51 The Integrative Approaches Dollard and Miller (1950) tried to understand psychodynamic concepts through behavioral or learning theory language. Jerome Frank examined the commonalities of various methods and found that they all include instilling hope in the patient, encouraging improved morale and understanding of self and others, a healing setting (e.g., psychotherapy office), and supporting change outside of the treatment environment.

52 The Integrative Approaches Others focused on the nature of the professional relationship as being a common curative factor in all types of therapies.

53 The Biopsychosocial Approach Since the 17 th century and the influence of Descartes and Newton, theories of health and illness have tended to separate the mind from the body. Western medicine view sickness as being influenced either by biology, such as genetics and neurochemical imbalances, or by the mind, such as personality and interpersonal conflicts.

54 The Biopsychosocial Approach During the last half of the 20 th century, advances in medicine, science, psychology, sociology, ethnic and minority studies have provided evidence for interactive multidimensional influences on health and illness.

55 The Biopsychosocial Approach New discoveries in genetics and neurochemistry, such as neuroimaging, have hardened the contribution of biology to emotion and behavior. The effectiveness of psychotropic medications provided evidence to the biological influences impacting behavior.

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57 The new theories provided evidence to psychological and social factors influencing health, illness, and behavior. The community mental health movement demonstrated the influence of social, cultural, and economic factors.

58 The Biopsychosocial Approach emerged during the late 1970s. In 1977, George Engel published a paper that proposed the biopsychosocial approach as the model of understanding and treating illness. The approach suggests that physical and psychological problems are likely to have a biological, psychological, and social element that should be understood in order to provide effective intervention strategies.

59 The Biopsychosocial Approach The biological, psychological, and social aspects of health and illness influence each other. When designing treatment and prevention interventions, an understanding of these interactions should be taken into consideration.

60 The Vail Conference A turning point in the training of clinical psychology occurred during the 1973 Vail Conference. The Conference aimed to discuss how training could be altered to accommodate the changing needs of both clinical psychology students and society.

61 The Vail Conference In addition to the Boulder or scientist-practitioner model, the Vail or scholar-practitioner model was an alternative. This model suggested that clinical training could emphasize the delivery of professional psychological services while minimizing research training. Graduate training need not occur only in university psychology departments but could also occur in professional schools of psychology.

62 The Vail Conference The Conference approved the PsyD (or doctor of psychology) degree as an alternative to the PhD degree.

63 Salt Lake City Conference During 1987, the National Conference held another meeting to examine how training models best fit the needs of students, society, and the profession.

64 Salt Lake City Conference This Conference approved the notion that all graduate training in clinical psychology, regardless of the degree (PhD or PsyD) or setting (university or professional school), should include a core curriculum containing courses such as research methods, statistics, professional ethics, history and systems, psychological assessment, and on the biological, social, cognitive, and individual difference bases of behavior.

65 Salt Lake City Conference The Conference stated that all APA accredited programs should at least be affiliated with a regionally accredited university. This measure was passed in order to maintain better control over the professional schools. But, this recommendation has been ignored. The majority of professional schools of psychology are still not associated with any university.

66 New training model Clinical scientist model is a more research-oriented and scientific approach to training relative to Boulder and Vail models. It developed in the 1990s.

67 Michigan Conference on Postdoctoral Training The APA accredits and provides detailed guidelines for graduate and internship training, no APA guidelines have been provided for postdoctoral training. The Michigan Conference developed guidelines and plans for control and regulation of postdoctoral training.

68 Michigan Conference on Postdoctoral Training Recommendations included : the completion of APA accredited doctoral and internship training programs prior to admission to accredited postdoctoral training programs; at least two hours per week of face-to-face supervision by a licensed psychologist; and a systematic evaluation mechanism for examining the trainees.

69 The rise of Empirically Supported Treatments Empirically supported treatments are well-established treatment approaches. Standards for empirically supported treatments : They have received significant research support demonstrating their efficacy using between- group design or single-case design methods.

70 Empirically Supported Treatments Results must have demonstrated superiority to placebo or other treatments. Experiments must have used enough subjects. They must have used treatment manuals. The effects must be found by two independent researchers.

71 Empirically Supported Treatments Examples: Exposure treatment: phobia, PTSD. CBT: headache, panic, bulimia, irritable bowel syndrome Insight-oriented dynamic therapy: depression, marital discord.

72 Evidence-based practice Evidence-based practice attempts to integrate the best available clinical research with quality clinical expertise to help the unique individual seeking professional services get his/her needs met.

73 Significant recent events: 1970 DSM II published 1973 Vail conference, 1980 DSM III published 1981 APA ethical standards revised 1982 Health psychology defined 1985??????? 1987 DSM III-R published 1987 Salt Lake City conference

74 Significant Recent Events 1988 American Psychological Society founded 1992 Michigan Conference 1994 DMS IV published 2002 APA ethics code revised 2002 New Mexico allows psychologists medication prescription authority

75 Present Status Diversity in gender, culture, ethnicity, language, religion, sexual orientation, physical ability and disability, and the entire spectrum of individual differences has been important for the practice. Training itself is undergoing significant changes. The gender distribution of clinical psychologists has changed from being mostly men to being mostly women.

76 Present Status Economic factors in health care are altering the field. Significant reductions in funding Solo independent practice may become less attractive as a career option in the future. Clinical psychology has expanded beyond the mental health field into the general health care and preventative health care fields.

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