Saturday, August 27, 2011
Examination of Clinical Psychology
Clinical psychology's rich history spans from early Greek philosophers to Sigmund Freud, to modern psychology wherein lies a body of information drawn from science, philosophy, and other realms. Scientific exploration continues to evolve and transform clinical interventions as empirically based evidence supports the principles by which clinical psychologists treat human challenges. Although various distinctions exist between clinical psychologists and other psychological disciplines, all endure to promote a better quality of life from and for the human spirit (James & James, 1991).
The History of Clinical Psychology
Long before Lightner Witmer opened his clinic in 1896 and coined the term clinical psychology, history provided remarkable developments, each providing a steppingstone for new scientific and medical exploration. Greek history provided a rich background in the sciences when early Greek thinkers recognized the interconnectedness of the mind and body and the influence this relationship had on illness. Hippocrates, Plato, and Aristotle saw the "spirit or soul as being in charge of the body and that problems residing in the soul could result in physical illness" (Mora, 1985 as cited by Plante, 2011, p. 34). During the Middle Ages mental and physical ailments were considered a breach in character, and consequently healing disease and insanity became an issue of the spirit. Later the Renaissance brought a return of scientific exploration, rendering supernatural and religious viewpoints unscientific. Biomedical reductionism established illness was more accurately understood by scientific observation and experimentation rather than spiritual and metaphysical beliefs (Plante, 2011).
In the nineteenth century, Sigmund Freud and his colleagues began to have a more articulate understanding of the mind/body connection which "reawakened the notion that a more holistic view of health...was necessary for a fuller understanding of health, illness, and abnormal behavior" (Plante, 2011, p. 46). Freud theorized unconscious directives exert powerful influence on health and well-being, recalling the early Greek philosophy of the inextricable connection between the mind and body (Parsons, 1958). Freud's psychoanalytic thinking inspired the need to accommodate individual demands, which remains central to contemporary clinical psychology (Brown, 1940).
The birth of psychology came with the development of the first laboratory established by Wilhelm Wundt in Germany in 1879, and exerted into prominence with the 1890 publishing of William James' Principles of Psychology. Shortly thereafter, the newly founded APA elected G. Stanley Hall as its president. Although the new idea of applying psychological principles to human ailment was not initially well received by his professional colleagues, Witmer opened his clinic in 1896, and provided a venue for such application (Plante, 2011). Both World Wars played a significant role in the need for clinical psychologists, first in developing psychometric assessments, and later to provide services to more than 40,000 veterans hospitalized for psychiatric reasons. Conferences at Boulder, Colorado in 1947 and later at Vail Colorado in 1973, supported the development of new models of clinical training and guidelines for the education of clinical psychologists. In 1977, George Engel created the biopsychosocial model of treating mental illness, which suggested physical and psychological illnesses have biological, psychological, or social components that must be understood to provide effective treatment (Plante, 2011).
Clinical Psychology's Evolving Nature
Clinical psychology has an intrinsic mechanism that creates its ongoing evolving nature, defined by its association with modern medicine and its use of the scientific method (Kazdin, 2008). As the high-tech standards of modern medicine and neuroscience continue to unearth new discoveries about the human brain and its connection to thought and behavior, clinical psychology evolves its applications according to new empirical evidence. "Central to this evolution has been the titanic human struggle to understand abnormal behavior in the context of the mind and the body" (Plante, 2011, p. 31). Contemporary clinical psychology embodies the scientific advances of science while incorporating a deeper understanding of the human psyche, and even the spiritual nature of humanity, which is enveloped in the context of the evolving human condition. As research and practice unite to provide continued improvement to patient care, the relationship between the two is an essential component to its evolving nature (Kazdin, 2008). According to Kazdin (2008), one of the conundrums between clinical psychology and research is the clinician's best effort to "tailor treatment to meet the needs of individual patients" (p. 17) when such individuality has no defined protocol supported by empirical research.
The Role of Research and Statistics in Clinical Psychology
At the foundation of clinical psychology is research, which provides answers to questions by which the science continues to actively learn, and from where it derives its evolving nature. Statistics, as part of the scientific method allows researchers to determine whether information is significant and applicable to wider populations. Research is an essential component of clinical psychology because it augments therapeutic applications, improving the quality of life for many individuals and determines more effective ways to diagnose, treat, and understand human behavior (Plante, 2011). Using the scientific method and statistically significant evidence, clinical psychologists develop critical thinking skills, which benefit both research and clinical settings, and gain knowledge, which precedes the ability to design effective treatments. According to Plante (2011), "research is fundamental to both the science and practice of clinical psychology" (p. 106). Evidence substantiated by statistical significance allows clinicians to apply proven therapies and theories confidently, knowing their work is corroborated by the dependable and reputable methods of science (Plante, 2011).
Although there are different ways to design experiments and research, each method has unique advantages and disadvantages, but all seek to effectively and scientifically study important issues without bias. One of the most challenging goals in psychology is ethically studying issues that translate into practice in a clinical setting. Effective clinical psychologists maintain current knowledge of research in their work with patients, knowledge without which, relegates psychological practice to the common anecdote. The future will undoubtedly include higher technology and more refined answers pertaining to the connection between the mind and the body but will most likely continue to "integrate methods and knowledge from disciplines such as medicine, sociology, and epidemiology" (Plante, 2011, p. 106).
Clinical Psychology as it Differs from Other Disciplines
Differences between clinical psychology include specific training and focus, and may require different graduate degrees. School psychologists typically have master's degrees and work in elementary, secondary, or special education programs or maintain private practice, and their primary focus is working with students and their families (Plante, 2011). Social workers, like school psychologists typically have a master's degree and provide direct services to clients in clinical settings that may include schools, hospitals, clinics, and private practice. A common focus (but not necessarily the only one) for social workers is often following and managing individual case studies (Plante, 2011). Training for social work involves less emphasis on the biological components of illness and their influence on behavior as well as less attention paid to research.
Counseling psychology is similar to clinical psychology and many believe there is no need for the two separate branches (Kinderman, 2009). Psychiatrists are physicians with special training in psychiatric medicine usually during medical internship and have an extensive training in the biological basis of behavior and behavioral problems. Other mental health care professions such as psychiatric nursing, counseling specializations, and occupational therapy, offer clinical services similar to those offered by school psychologists, psychiatrists, and social workers. Although clinical psychologists differ in some respects from other mental health-related professions, each discipline aims to "use the principles of psychology and [the] understanding of human behavior to promote health, happiness, and enhanced quality of life" (Plante, 2011, p. 27-28).
Many factors contributed to the genesis of clinical psychology as an independent discipline. Its evolution has been continual with a constant influx of new scientific information in biology, chemistry, physics, and technology. The contributions of Freud and psychoanalytic thinking inspired the notion of individuality in therapeutic design, which continues as a fundamental underpinning to clinical psychology. Although clinical psychology maintains differences with other psychological disciplines, the existence of the mental health-related professions embrace a primary aim to accommodate the psychological needs of humankind and provide a realistic and enduring ability to thrive, tailored empirically for the human spirit.
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Kazdin, A. E. (2008). Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63(3), 146-159. doi: 10.1037/0003-066X.63.3.146
Kinderman, P. (2009). The future of counselling psychology: a view from outside. Counselling Psychology Review, 24(1), 16-21.
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