The Origin and Evolution of Clinical Psychology

¶ … old, the profession of clinical psychology is "one of the most vigorous fields of psychology," (Reisman, 1991, p. 3). Clinical psychology refers generally to both social science research and application of that research to achieve specific clinical goals related to mental health. Since its inception in the 1890s, the field has changed and evolved dramatically (Benjamin, 2005). Earliest forms of clinical psychology included working with asylum patients, which often entailed using a variety of techniques that are now deemed unethical or harmful. The rise of psychoanalysis based on Freud's teachings led to the 20th century being an era in which talk therapy prevailed. Research on different models of talk therapy has informed best practices in general. However, recent changes to the field of clinical psychology attempt to distinguish between the types of quantifiable evidence that can be gained from empirical research using psychopharmacological interventions on the one hand and less tangible, less measurable means like counseling on the other hand. Clinical psychology seeks to establish itself as a social science, which is why research and statistics play a major role in the field.

Clinical psychology distinguishes itself from other social science professions in a number of ways. The field of clinical psychology is also broad. Generally, clinical psychology emphasizes research and evidence-based practice. The field has considerable overlaps with other fields including psychiatry and counseling psychology. As clinical psychology is focused on individual or micro-level variables of analysis, the field is clearly distinguished from that of social work. Clinical psychology also relies on both qualitative and quantitative research methods. Unlike psychiatry, clinical psychology does not necessarily depend on medical interventions but does include medical interventions when they are indicated by research. As clinical psychologists are not medically trained as psychiatrists are, they are not legally permitted to prescribe pharmacological interventions. Therefore, clinical psychologists frequently work with other members of a healthcare team including psychiatrists or social workers.

Some clinical psychologists remain dedicated to scientific research or academia, whereas others are practitioners. Researchers inform practice, but often clinical data is gathered not from real-world interventions but with targeted clinical trials. It is difficult to bridge the gap between research and practice, as professional clinical psychologists who only see clients and who do not perform research may become disconnected from emerging science and not providing clients with the most effective or cutting-edge interventions. As Lilienfeld, Lynn & Lohr (2015) point out, one of the most significant problems with clinical psychology is the fact that practitioners "routinely neglect research evidence," and "commonly administer therapeutic and assessment methods that are either unsupported or inadequately tested," (p. 1). Just as lobotomies and other invasive procedures characterized some of the early foibles of the field, pseudoscientific therapies remain an issue affecting both the credibility of the field and client outcomes.

Ideally, clinical psychologists remain ethically and professionally committed to evidence-based practice. Clinical psychologists are, however, entitled to recommend or even perform therapeutic interventions not necessarily rooted in evidence but which may nevertheless be beneficial to the client so long as professional ethical standards are being maintained (Barlow, 2011). It is important to note that even some of the most established trends in the field of clinical psychology may not be scientific in nature. For example, Freudian psychoanalysis, long a standard talk therapy modality, has not necessarily proven itself effective with statistical significance (Lilienfeld, Lynn & Lohr, 2015). Clinical psychology cannot be an exact or hard science.

Professional organizations like the American Psychological Association have ensured that the field and its practitioners have standards and that those standards evolve over time to reflect recent scientific evidence. After World War Two, clinical psychology blossomed and gave rise to systematic diagnoses and treatment programs to ensure that the field more closely resembled medicine. A major landmark in the field of clinical psychology was the publication of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM), which is currently in its fifth edition. The manual serves as a bible in the field, informing clinicians about the signs and symptoms of various mental disorders and psychiatric conditions. Using the DSM ensures that licensed clinical professionals make their diagnoses based on professional standards, even when the judgments are subjective and potentially subject to bias. Even the mental health conditions outlined in the DSM reflect cultural biases and social norms, which is why the conditions and their characteristic features often change over time. For example, homosexuality had once been officially pathologized (Barlow, 2011).

Shifts in social norms can be particularly problematic for clinical psychologists attempting to enhance the legitimacy of the profession. Misdiagnosis and over-diagnosis can lead to problems such as stigmatization or labeling, and could worsen pre-existing psychological or social problems. On the one hand, clinical trials ensure that treatment interventions have actually been shown to be effective on specific populations at specific times. On the other hand, the efficacy of interventions depends on a wide range of micro-level, meso-level, and macro-level variables. An over-reliance on quantifiable evidence has led to a situation where clinical psychologists are pressured to recommend psychopharmacological avenues rather than on talk therapy and other non-medical interventions. It is therefore important for clinical psychologists to accept that their field blends art and science, but without resorting to pseudoscientific and therefore unethical interventions.