The great evangelist D.T. Niles once said, “Christianity is just one beggar telling another beggar where to find bread” (Niles, 2010). At its most basic level, clinical psychology is the enterprise of one educated, licensed person using his or her knowledge of human behavior to address, assuage, or otherwise moderate the troubles and concerns of another person’s life—whether they be relational, affective, or physiological. Strictly speaking, clinical psychology is, “the assessment, treatment, and understanding of psychological and behavioral problems and disorders” (Plante, 2011, p. 5).
Clinical psychology is a scientific endeavor, utilizing the instrument of the scientific method to inform the practice, procedures, and treatments used to address human problems. There is an interplay that exists between treatment outcome research and psychotherapy in clinical psychology—the science informs the art and the art informs the science (Plante, 2011). The point of this paper is to catalogue and compare the history and evolving nature of clinical psychology as well as to consider the specific case of counseling within the framework of clinical psychology.
Hippocrates—the original author of the Hippocratic Oath—formed the first complete, if naïve, physiological explanation of disease and dysfunction (Plante, 2011). He proposed that imbalances in the mixture and quantity of four fluids: black bile, yellow bile, phlegm, and blood, caused several emotions and psychological maladjustment, such as sadness, irritability, and anger. It was not until the advents of Plato that it was conceived that the metaphysical realm of the soul could have an effect on the corporeal domain. However, it was to Galen that a holistic theory of medicine was formed that incorporated the physiological explanations of Hippocrates with the metaphysical explanations of Plato. Even though Galen’s ideas of bloodletting were flawed, it was a step in the direction of objective explanations of illness and disease.
During the middle ages the work of Thomas Aquinas, Paracelsus, and Weyer shifted the discussion of psychology away from the metaphysical and toward physical explanations of mental illness, such as bodily causes, movements of the stars, and behavior. Furthermore, at the dawn of the Renaissance and into the nineteenth century the veil of shadow and secrecy behind the inner workings of the mind, body, and cell were ripped from his or her places and the mediums of scientific observation and laboratory investigation were instituted in the place of religion and mysticism as the sole explanation of illness.
The works of Rush, Bernard, and Pinel during this period of history paved the way for more humane approaches to the abnormal and deviant—approaches that sought to alleviate psychological dysfunction rather than simply separate and restrain the dysfunctional. The birth of psychology proper came on the heels of the publishing of Wundt’s The Elements of Psychophysics in 1850 and James’ Principles of Psychology in 1890 (Plante, 2011). These publications, along with the institution of the first psychological laboratory by Wundt, culminated in the founding of the American Psychological Association (APA) in 1892. The main drive behind the fledgling field of psychology was to measure empirically behavior to the end of understanding the subsidiary components of the mind itself.
Hence, when clinical psychology first got on its feet four years later (1896), through the opening of the first clinic by Witmer, many psychologists frowned upon the application of the principles of human behavior to clinical situations. This was seen as a step away from a general understanding of human behavior and toward abnormal or dysfunctional psychology. Despite the initial tension between clinical psychology and mainstream psychology, the first formal classes in clinical psychology began in 1904 at the University of Pennsylvania and the first edition of the Journal of Abnormal Psychology was published in 1907.
Despite the disinclination of the APA to embrace an applied approach to psychology, clinical psychology grew rapidly in the beginning of the twentieth century (Plante, 2011). Going back to Plato’s contention of the metaphysical affecting the corporeal, Sigmund Freud postulated that unconscious conflict and strife could have a direct outcome on mental and physical illness. The work of Freud shaped and molded the direction of clinical psychology for many decades after his death. Even though it was not until the Boulder Conference of 1949 that the training guidelines for clinical psychology were mapped out and etched in stone, so to speak.
One of the main tenets of these guidelines was that clinical psychologists should have a firm understanding of both psychological research and psychotherapy. It was not until the 1950s and on that Freud’s ideas of human psychology were exchanged for the alternatives of humanism, cognitive-behaviorism, and family systems approaches (Plante, 2011). The changes in psychological perspective were precipitated by the establishment of community mental health facilities and the introduction of psychotropic drugs as a treatment of abnormal psychology.
Even though these advancements in conception and treatment offered alternatives to the traditional ideas of psychodynamics and behaviorism, no one theory of human psychology proved to explain the entirety of behavior, dysfunction, and cognition. To that end, parsimoniously eclectic approaches to psychology were adopted—such as the biopsychosocial theory—that incorporated many of the ideas and practices from the abovementioned perspectives.
The last century of clinical psychology has been characterized by an illness ideology that emphasizes the treatment or preventions of disorders (Maddux, 2008). Even though this approach has utility in the realm of psychotherapy it lacks the ability to enhance the quality of life for people who do not suffer from some type of mental illness. Maddux (2008) proposes that a shift toward positive psychology—a perspective that stresses human strengths and mental health—should be pursued. Positive psychology aims to, “…promote health, happiness, physical fitness, and pleasure, and personal fulfillment through the free pursuit of chosen and valued goals” (Maddux, 2008, p. 68).
By shifting toward positive psychology the strengths of people can be used to promote mental health preemptively as well as combat mental illness. At the forefront of the implementation of positive psychology is the innovation of virtual reality (VR) as a means to allow patients to manipulate problematic situations related to his or her mental illness without the use of psychotherapy (Riva, 2009). By creating a safe and comfortable virtual environment patients can explore proactive ways to adapt and mediate his or her mental health problems.
Research and Statistics in Clinical Counseling Psychology
Rather than approach this section from a structuralist approach (e.g. the ancillary parts of clinical counseling psychology), it seems prudent to offer a specific example of how research and statistics are used and effect clinical counseling psychology. Bakar, Jaafar, Mohamed & Tarmizi (2009) sought to establish a correlation between counseling self-efficacy and trainee counselor performance. Their research found that indeed there is a positive relationship (r(100)=.312p<.05) and furthermore that a general tendency exists whereby self-efficacy predicts future performance.
As Plante (2011) put it, “The science of clinical psychology informs the art while the art also informs the science” (p. 6). In the case of Bakar’s et al. (2009) research, by using the statistical data collected in their study the art of counseling can be influenced and adapted by the science of research and statistics. Specifically Bakars et al. suggested that the training of supervisors is of paramount importance to trainee self-efficacy, because high competence in the supervisor encourages high competence in the trainee.
In sum, from the first theory of interplay between the metaphysical and the corporeal to the first postulations of a biological basis for mental illness, the investigation of the human condition has sought an explanation for the relationship between psychology and physiology. As the history of psychology in general progressed there was a tendency to seek out more empirical, scientifically ascertainable explanations of human behavior.
However, as clinical psychology rose in the late 19th century and early 20th century an applied approach to mental illness was adopted that emphasized a hands-on method to treatment. Currently there is a shift in clinical psychology toward prevention and human strengths and away from the illness ideology of the past century. This can be seen most readily in the institution of VR as a preemptive approach to mental illness. Research and statistics act for clinical counseling psychology as a compass or corrective instrument to inform the practice and training of clinical counseling psychologists.
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