Clinical Psychology Theories
Clinical psychology represents that branch of psychology concerned with deviations in personality functioning, or behavior we term as abnormal or pathological. The study of behavior in its abnormality is important in our search for understanding normal human behavior, just as in medicine the study of pathological tissues has contributed to the understanding of how normal cells function.
The field of clinical psychology has come to represent at least two major areas of endeavor. One area centers on the science of the field—the study of behavior in its abnormality. The science of clinical psychology is conducted mainly in universities, medical schools, and large public and private clinical facilities, often supported by governmental grants. The researchers, predominately with Ph.D. degrees in psychology, have been trained in experimental methods and are devoted to the pursuit of scientific inquiry.
The second area is the practice of the field—the application of a whole range of techniques designed to evaluate and alleviate mental and emotional problems. The practice of psychology takes place primarily in hospitals, community mental health centers, or private clinical settings by clinical psychologists as well as a wide range of other mental health professionals, including psychiatrists, social workers, psychiatric nurses, and mental health counselors. A mental health clinician’s educational background varies according to the particular academic or professional field, but must involve at least graduate work at the master’s level and the possession of a state license. For psychologists to practice independently in the field and to be full members of the national professional association (American Psychological Association), they must earn a doctorate.
Professionals who chose both to do research and to practice in the field of clinical psychology have traditionally earned Ph.D. degrees in programs dedicated to the “scientist-professional” or Boulder model of training, emphasizing both scientific and professional areas, as delineated at a conference in Boulder, Colorado, in 1949. Other models emphasizing various aspects of clinical psychology, such as the role of clinical training in dealing with school and community problems in the area of mental health, have been developed over the years. Most recently, there has been a rapid growth of doctor of psychology or Psy.D. programs, which place heavier emphasis on the application of clinical skills over the research of clinical problems.
Whatever the path of training or the degree obtained, the clinical psychologist is an applied scientist or a scientist practitioner who utilizes scientific knowledge in the field to beneficial ends.
Before discussing the current theories in clinical psychology, let us briefly explore the theoretical frameworks that have guided the discipline as it has evolved through the ages. From earliest historical times, humans have been fascinated by deviant behavior and have attempted to develop theories for explaining the phenomena. As expected, most theories have been in keeping with the prevailing cultural and intellectual context of the times. Whenever new theories differ from the accepted contemporary beliefs, they are often ridiculed, rejected, or even condemned. Whether a new theoretical avenue is a true breakthrough or a cul-de-sac may be determined only with time.
The earliest conceptualizations of aberrant behavior attributed abnormality to magical causes, spirits within the brain, or punishment for sins (Walker, 1991). Evidence for these theories appears in early findings of skulls and in writings going back to the Babylonians in 2100 BCE. In keeping with the beliefs of those times, in order to rid an individual of the abnormality, holes were made in the skull (trepanning), appeals were made to the gods by medicine men, or persons with such behavior were made spectacles of, or even banished from society.
During the Golden Age of Greek Enlightenment (500-300 BCE), abnormal behavior or mental illness was conceived of as emerging from within the corpus of the person, mainly as excesses of certain bodily humors in the blood and other fluids. Because aberrant behavior was viewed as a physical condition, the treatment of such illness came within the province of the emerging medical profession. However, philosophers at the time also distinguished the mind from the body and attempted to understand “disordered thought” in terms of irrational thinking. Thus, the mind/body or biological versus psychological dilemma over the causes of abnormality was argued from the onset of rational thinking.
This early dichotomous theorizing about the foundations of abnormal behavior—organic vs. functional— remains with us today in the still unresolved determination of the etiology of many behavioral pathologies.
Those who have pursued the theory of organic origins of mental illness, mainly psychiatrists and neurologists, have experimented with shock treatments, brain surgery, diet regimes, and medications. Today there are a number of effective psychotropic drugs that alter emotions, thinking, and behavior in mentally distressed persons. These remedies have not resolved the questions on the origins of the mental illness, although they may go a long way in alleviating much of the suffering of persons with mental disorders.
Clinical psychology has developed many theories attempting to explain behavior aberration as a function of psychological interactions or reactions to stressful events. For the most part, these theoretical formulations have been divided into three main movements in the mental health field.
The first major efforts in the modern era to conceptualize mental and emotional distress in functional terms were undertaken by psychoanalysts. The founder of the movement and the most articulate of this point of view was Sigmund Freud (1856-1939), who determined that the interactions of the child with parents during crucial stages of maturational development were the significant elements in the eventual personality functioning of the adult. In the late nineteenth century this was a radical departure from the emphasis on organic factors as causes of mental illness, and many of Freud’s theories—especially those involving early “sexual” feelings in children—drew much criticism and derision from the medical community as well as the public at large.
The theories of personality deviation based on dynamic relationship factors were supported by reports of case studies, using the psychoanalytic method of treatment. The technique called for the patient to “free associate” (say whatever came to mind) in a session with an analyst. As the patient reviewed his or her (interestingly, women were the predominant ones in treatment) history of relationships, the therapist came to represent various significant figures in the patient’s life. The feelings associated with the earlier relationships were transferred to the analyst. Through the reliving of early emotional experiences, the patient gained insight into the sources of emotional distress and conflict, released the psychic energy used to cover up or repress the stressful memories, and was then able to function normally.
Today, the technique of psychoanalysis has been modified greatly to include the patient’s functioning in everyday life—not just childhood—and the earlier requirement for long (four to five years), intensive (four to five days a week) sessions has been reduced to shorter, more practical terms.
At the time of Freud’s early writings, psychologists were just emerging from the philosophical and physiological departments of universities, studying basic human phenomena such as reaction time and perceptual awareness. It was not until 1896 that Lightner Witmer (1861-1956), a member of the psychology faculty at the University of Pennsylvania, started a clinic for treating educational and behavioral problems. Eleven years later he founded a journal called The Psychological Clinic, which contained articles describing the work of the clinic and a new “clinical” approach to dealing with learning deficiencies and behavioral dysfunctioning. Witmer determined that both biological and psychological factors contributed to such problems. Known as the father of clinical psychology, Witmer is still a model for the present-day clinician who considers all the physical and psychological aspects of the individual in assessing and treating persons with dysfunctional behavior.
The second wave of theoretical conceptions of personality development bearing on the field of clinical psychology was initiated in the mid-1920s by the behaviorists, led by J. B. Watson (1878-1958) and B. F. Skinner (1904-1990). They viewed behavior as responses to the rewards and punishments experienced by individuals as they grew. The behavior might be reflexive, based on physiological or psychological stimuli; or more complex, due to the instrumental acts in seeking to meet needs (drives).
The behavioral school placed the issues of abnormal behavior squarely in the realm of the clinical psychologist, who studied the science of behavior and applied the knowledge gained to understand and reduce deviant behavior. In the middle of the twentieth century, clinical psychology flourished with exciting experiments demonstrating the effects of stimuli on responses, establishing the principles of generalization and discrimination gradients, and developing desensitization techniques that rapidly altered thinking and modified behavior. Manuals for child training, personality enhancement, and control of aberrant behavior based on behavioral techniques were popular with the profession as well as with the public at large. At last, clinical psychology had techniques based on scientific evidence tested under controlled, laboratory conditions, instead of reports of case studies and theorizing. As with psychoanalysis, behavior theory today has evolved and modified to include cognitive factors and greater complexity in approaching clinical problems (Fishman & Franks. 1992).
The third wave of clinical theorizing came in the 1940s, with leaders in the Gestalt field, such as Fritz Perls (1893-1970) and in the client-centered field, singularly led by Carl Rogers (1902-1987). The movement was partly a reaction to the somewhat authoritarian psychoanalytic approach and the sterile precision of the behavioral approach. A number of psychologists began to view the human condition in more existentialist, humanistic terms. The new approach to psychological problems included greater acceptance of individuality, sharing of feelings, and genuine regard for the person, whatever the behavior. Mental problems came to be understood as the failure to realize the fullness of one’s humanity (Richly. 1981) and thus were treated with compassion and acceptance. The effectiveness of therapy relied on the human encounter between the therapist and the patient, who changed due to trust and the belief in the genuineness of the regard for the patient. Without emphasis on insight or behavioral regimes, the patient was enabled to exercise freedom of choice with maturity, independence, and responsibility (Brems. Thevenin. & Routh. 1991).
These three major theoretical frameworks of clinical psychology are broad representatives of many variants they have spawned and the myriad formulations of personality that clinical psychology embraces. Recent attempts to integrate theories (Arkowitz. 1992) and to treat emotional and behavioral problems with more eclectic approaches have gained in popularity. The Society to Explore Psychotherapy Integration sponsors a journal and holds international conferences each year to discuss developments in the theoretical and practice approaches to understanding and treating psychological problems.
Clinical psychology along with the other mental health professions has expanded its study and work into many areas, including marital and family conflict, career changes, addictive behaviors, conflict resolution, natural and accidental disaster response, and living situations that require emotional coping skills. The knowledge obtained through research is invaluable in guiding the interventions necessary to meet these demands. And the experiences from the endeavors of mental health helpers provide important material for guiding the research and eventual theory building that is the work of clinical psychology.
See also:
- Clinical Psychology History
- Clinical Psychology Assessment
- Clinical Psychology Interventions
- Clinical Psychology Bibliography