Clinical psychology born and raised in controversy

VOLUME 30, NUMBER 11 December 1999

As the century turns, the methods and roles of clinical psychology continue to be under scrutiny and discussion.

Today, the man who popularized the term "clinical psychology" might not recognize it. But Lightner Witmer would surely be familiar with debate over clinical practice, which is just as common in the waning days of this century as it was in 1896 when he opened his first clinic.

Witmer, who earned his doctoral degree in Germany under Wilhelm Wundt, saw psychological clinics as a community service. At first, there was little response to his call for clinical involvement by psychologists, but by 1914 there were 26 more clinics operating in the United States.

While Witmer emphasized the intellectually subnormal populations, others were focusing on mentally ill populations, including S.I. Franz, William O. Krohn and physician Edward Cowles. Meanwhile, clinical psychology was advancing in mental hospitals as psychologists gained positions on hospital staffs, working alongside psychiatrists.

Witmer also furthered the underpinnings of the field by founding in 1907 both the Orthogenic School at the University of Pennsylvania Hospital and the journal Psychological Clinic.

But the professionalization of clinical psychology grew slowly. It wasn't until 1917 that clinical psychologists began to organize under that name. That year, the American Association of Clinical Psychology was organized. The group lasted only briefly until APA formed its Section on Clinical Psychology. This section certified clinical psychologists until 1927, but would not allow clinical psychologists full membership in APA. Many clinical psychologists went to the American Orthopsychiatric Association, founded in 1926, which allowed them full membership. Morton Prince established the Harvard Psychological Clinic in 1927, seeking to bring together academic and clinical psychologists in a productive team.

Slow growth of the field continued in the 1930s as several scattered, applied psychological organizations formed an alliance under the American Association of Applied Psychology. This group became the primary forum for clinical and applied psychology until APA reorganized in 1945, creating its division of clinical psychology, today known as Division 12.

World War II changed everything. The supply of psychotherapists was outstripped by the demand for those who could treat war neuroses and other psychological problems brought on by the conflict. Military hospitals accepted psychologists in therapeutic and diagnostic capacities. As a result, the Veterans Administration and the U.S. Public Health Service liberally funded clinical training programs, considerably altering the theoretical and professional balance of most psychology departments thereafter.

But this new teaching and training of psychologists within academic settings required some definition. In 1947, David Shakow and a committee on clinical psychology graduate training answered that challenge, drafting a report that led to the scientist/practitioner model, known today as the Boulder model. The model called for clinical psychologists to train as scientific psychologists first, rather than focus only on clinical skills.

Over the years waves of theories have influenced the field. Freudians and neo-Freudians were paramount immediately after World War II. Later, in the 1950s and 60s, Carl Rogers's client-centered therapy became a major rival for therapeutic practice.

The dominance of behavior theory and method in academic psychology led to the evolution of behavior therapies to be developed in the field. Methods bred of new technology also entered the field, such as biofeedback techniques.

A reaction to this "mechanistic" approach in the 1960s took the form of humanistic, existential and phenomenological approaches. Rollo May, Ernest Angel and Henri Ellenberger's "Existence: A New Dimension in Psychiatry and Psychology" defined a portion of the clinical field.

Fritz Perls's Gestalt therapy also gained popularity during this time, along with Viktor Frankl's logotherapy and George Kelley's personal construct theory. Rogerian therapies continued to be popular as Freudian therapies waned. Sensitivity training and "T groups" appeared everywhere well into the 1970s.

As the century turns again, the methods and roles of clinical psychology are once more under scrutiny and discussion. Professional issues such as third-party insurance payments, the changing nature of practices and the prescribing of drugs by psychologists are in active contention.

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