CHAPTER 13 (GOODWIN) – PSYCHOLOGY’S PRACTITIONERS

Dr. Nancy Alvarado

Research vs Practice

Psychology

Experimental Psychology

Clinical Psychology

Psychonomic SocietyAPS (Association for Psychological Science)

Ph.D.

APA (American Psychological Association)

Ph.D. or Psy.D

Ph.D vs Psy.D vs MD

Clinical Practice

PsychiatryClinical

Psychology

Clinical Research

Mental Health Care

M.D. withInternship in Psychiatry & board certification +Psychoanalytic Training (optional)

Ph.D. with research dissertation + clinical internship & licensure

Psy.D with supervised practice instead of dissertation + clinical internship & licensureWork in universityWork in clinic

Work in hospital or clinic

What About Counseling?

Psychiatry

Problems with Living and Personality Disorders

Major Axis disorders

(mental illness)

Clinical Psychology

Mental Health Care

•Counseling (MFT & school)•Social work and social service agencies•Pastoral counseling•Therapy for adjust- ment problems

Therapy, diagnosis and testing, coordination of care in agencies/institutions

Management of drug and other medical treatment, evaluation of organic factors, institutional care

Researchers vs Practitioners Prior to WWII, academic psychology dominated the

APA but that gradually changed. First, clinical psychologists formed other organizations. The balance shifted in 1962 when those in

nonacademic (clinical) jobs outnumbered academics. The APA was restructured in 1982 to include divisions to

restore the status of experimental psychology. Experimental psychologists formed the Psychonomic

Society (1960) and later, the APS (1988). The split represents different values & interests.

The Limited Role of Psychologists Before the war, psychologists worked under

psychiatrists (who had medical training) and psychologists were limited to administering tests. There was little formal training except on-the-job.

During the war psychologists began providing therapeutic services because the need was so great. The govt NIMH funded training of clinical

psychologists. Psychologists were recognized as expert

diagnosticians and therapists, no longer restricted to a clinic setting or supervised by a psychiatrist.

Deaths in WWI

Deaths in WWII

Psychological Effects of WWII 40% of casualties of the Battle of

Guadalcanal (1942) requiring evacuation were psychological ‘breakdowns.’

Of the first 1.5 million medical discharges, 45% were for psychiatric reasons.

At the end of the war, 44,000 people were hospitalized at the VA for mental disorders, compared to 30,000 for physical wounds.

Psychiatry could not meet the need for treatment.

Battle Stresses

Trying to understand what had contributed to the tremendous psychiatric casualty levels of this prolonged battle, Lidz (1946, p. 194) concluded that:

“…there were many factors preying on the emotional stability of the men. The tension of suspense in one form or another was among the most serious; waiting to be killed, for death had begun to seem inevitable to many, and some walked out to meet it rather than continue to endure the unbearable waiting; waiting for the next air raid and the minutes of trembling after the final warning; waiting for the relief ships; waiting without acting through the jungle nights, listening for the sounds of Japs crawling, or for the sudden noise that might herald an attack; waiting even in sleep for the many warning sounds. The fears were numerous: of death, of permanent crippling, of capture and torture, of ultimate defeat in a war that was starting so badly . . . [as well as] fear of cowardice . . . and of madness.”

“In this first offensive battle of the war it became clear that the incapacitating wound could arrive with the mail from home . . . the loss of a girlfriend, the fight with parents” (Lidz, 1946, p. 195).

Examples of Shell Shock

Films of Shell Shock in WWI: http://www.youtube.com/watch?v=nsSkL3Yl

0rA&feature=related US Army documentary on battle stress

(1947): http://www.youtube.com/watch?v=eE6kw1

qp3n8 General Patton slapping incident (from

the movie Patton (1970): http://www.youtube.com/watch?v=Huxzr_k

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The Boulder Model

David Shakow headed the APA’s Committee on Training in Clinical Psychology (CTCP) in 1947. 71 professionals met at the Univ. of Colorado in

Boulder to create a blueprint for training. 3 forms of expertise were needed:

Diagnosis – training in assessment was provided. Therapy – a year-long internship was required. Empirical research – a dissertation was required.

This “scientist-practitioner” approach was known as the Boulder Model

The Eysenck Study

In 1952, Hans Eysenck published “The Effects of Psychotherapy: An Evaluation” suggesting that traditional psychotherapy was ineffective. He compared 5 psychoanalytic studies and 14

eclectic therapies with a control group of 2 studies of “neurotics” without treatment (from insurance records).

Improvement was 72% for controls compared to 44% for psychoanalysis and 64% for the eclectic therapies.

The methods were flawed but the study damaged the reputation of psychotherapy in the 50’s & 60’s.

Behavior Therapy

Behaviorists challenged psychoanalytic approaches by developing alternative therapies applying the results of their studies. Hobart & Mowrer developed a treatment for bed-

wetting involving a bell ringing when a sheet was wet, attacking deep-seated psychoanalytic explanations.

Eysenck developed “behavior therapy” & a journal.

Wolpe developed systematic desensitization, a behavior modification technique to treat phobias (irrational fears) based on learning theory.

Systematic Desensitization

He applied Mary Cover Jones’s approach of pairing a fear response with a pleasure response (counter-conditioning). Cats were shocked when they approached food,

then the fear response was replaced with food in rooms gradually changed to resemble the original room.

He used progressive relaxation to replace food when working with humans.

People develop an anxiety hierarchy then pair an imagined scene with relaxation until anxiety fades.

Other Behavioral Approaches Token economies -- Skinner Cognitive-behavior therapy

Ellis – rational emotive therapy Beck – treatment for depression based on

Seligman’s Learned Helplessness Behavior modification – based on analysis

of behavior and changing rewards.

Humanistic Psychology

Humanistic psychology rejected psychoanalysis and behaviorism. Human behavior cannot be reduced to

repressed biological instincts (Freud) or simple conditioning.

The past does not inevitably limit the future. People are characterized by free will, a sense

of responsibility and purpose, and a search for meaning in one’s life. There is an innate tendency toward growth

called self-actualization

Two Important Humanists

Abraham Maslow

Carl Rogers

Abraham Maslow

Maslow trained as an experimental psychologist studying dominance behavior in primates. He was hired as faculty at Brooklyn College then

moved to Brandeis University in 1951. He focused on the nature of psychological health

not disorders, examining the lives of self-actualized people (e.g., Ruth Benedict, Max Wertheimer).

He said self-actualizers see reality accurately, are independent and creative, have a strong moral code and see their work as more than a job.

Carl Rogers

After a very strict Protestant upbringing, Rogers studied theology at Union Seminary but switched to Columbia Teacher’s College and psychology. Leta Hollingsworth encouraged his interest in

child guidance. He disliked psychoanalysis during his training.

He spent 12 years as staff psychologist at a child guidance clinic in Rochester NY, developing his own therapeutic approach.

Rogers in Academia

In 1940 Rogers was hired at Ohio State University where he wrote “Counseling & Psychotherapy” in 1942. Then he moved to the Univ. of Chicago. He was elected president of the APA in 1946

signaling the shift from research to clinical psychology.

After 12 years in Chicago, he moved to the Univ. of Wisconsin, where his work was attacked.

In 1961 he moved to California, originally at the Western Behavioral Sciences Institute, then he founded the Center for the Study of the Person.

Client-Centered Therapy

Rogers rejected the need to delve into the client’s past but instead focused on creating a therapeutic relationship supporting growth. The therapist must be honest with the client. The therapist must be unconditionally accepting of

the client’s worth (by virtue of being a human being). The therapist must have empathy (understanding of

the client’s viewpoint) modeled using reflective listening.

Rogers conducted research to test the effectiveness of his approach. The approach was popular.

The Vail Conference

The Boulder Model had difficulties: Practitioners outside academia found little use for

their research skills and felt they had insufficient clinical training.

Grad students weren’t getting good clinical training because academics had no time for practice.

Crane proposed a new degree – Doctor of Psychology (Psy.D.), emphasizing clinical training.

The Vail Conference (1973) set standards for new programs, legitimizing the degree.

Recent Changes in the Field

Clinical psychology has gained respect and distinguished itself from psychiatry.

After legal battles, clinical psychologist now have the right to: Admit & release patients from mental

hospitals. Serve as expert witnesses in court. Receive payments from insurance companies.

Disputes over prescription privileges continue – a few states allow it.

Remainder of Chapter

The remainder of this chapter will be discussed during lectures later in the quarter when the Hothersall chapters focus on testing and people such as Cattell.

The remainder of this Goodwin chapter will not be on Midterm 2, but may be on the Final exam.