Transcript The Behavioral Approach

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 Clinical Psychology Immediately after World War II
 The Rise of Alternatives to the Psychodynamic
Approach
 A New Training Model Emerges: The Vail Model and
Professional Schools of Psychology
Clinical Psychology Immediately after
World War II
Following the war, over 40,000 veterans were
hospitalized. Psychiatrists were unable to meet the
treatment demands of these huge numbers of
veterans. It resulted in increase in the number of
clinical psychologists.
Veteran’s Administration hospitals became the largest
single employer of clinical psychologists in the USA.
Many others preferred to focus on the science of
psychology in academic environments.
There was a division between science and practice from
the beginning.
Training
The APA Committee on Training in Clinical Psychology
recommended that training be comprehensive in research,
treatment, and assessment.
In 1948, the APA began to carefully evaluate and accredit
doctoral training programs. Psychology departments in
universities across the USA had a freedom to determine
their training programs.
The Boulder Conference
Prior to 1949, psychology departments in universities
across the country had a great deal of freedom to
determine how they should run their training programs.
The Boulder Conference was called (convened) in 1949.
It was the first national meeting to discuss standards for
doctoral training.
The Boulder Conference
This training model stated that a PhD degree in
psychology from a universitybased training program
plus a one-year clinical internship were necessary for
adequate preparation.
The Boulder model became known as the scientistpractitioner model.
Clinical psychologists should be competent in both
conducting research and providing professional services
such as psychotherapy and assessment.
Post-Boulder Conference Events
Additional conferences convened to discuss the pros and
cons of the clinical psychology training model.
The growth of clinical psychology during the 1950s was
enormous.
APA membership more than doubled during the 1950s.
Post-Boulder Conference Events
In 1952, American Psychiatric Association published
diagnostic categories in Diagnostic and Statistical
Manual (DSM - I).
In 1953, the first attempt to outline ethical principles for
psychologists was published by the APA.
The Rise of Alternatives to the
Psychodynamic Approach
During the first half of the 20th century, the
psychoanalytic approach founded by Freud
and the behavioral conditioning approach
founded by John Watson.
The Rise of Alternatives to the
Psychodynamic Approach
During the 1950s, 1960s, and 1970s, many new
approaches were developed as alternatives to the
traditional psychodynamic approach:
 humanistic,
 behavioral,
 cognitive-behavioral, and
 family systems approaches
The Rise of Alternatives to the
Psychodynamic Approach
In the 1960s, the community mental health movement
rose. Psychotropic medication in treating mental illness
introduced. These two events had powerful influences
on clinical psychology.
The Behavioral Approach
The behavioral approach applies theories of learning
and conditioning to the understanding of human
behavior and the treatment of problems.
It had its roots in the conditioning research of Ivan
Pavlov in Russia. The behaviorism and learning theory
in the USA conducted by
John Watson, Edward Thorndike, Clark Hull, John
Dollard, Neal Miller, and B. F. Skinner.
The Behavioral Approach
Behaviorism became an attractive alternative to medical
and psychodynamic strategies during the 1950s and
1960s.
Some research-oriented clinicians felt that behavior
therapy proved more effective in empirical research
trials relative to traditional theories and methods such as
psychoanalysis.
The Behavioral Approach
The behavioral approach was viewed by many as more
scientifically based than the psychodynamic approach.
Behavioral techniques were more readily operationalized
to allow for research and statistical analysis. It was easier
to measure a person had a panic attack than measuring
constructs such as the id, transference, or unconscious
conflicts.
Pavlov (1849–1936)
The Behavioral Approach
Behavior therapy
approaches to treatment
were developed in South
Africa by Joseph Wolpe
(1915 - 1997). He developed
systematic desensitization
to treat phobias.
The Behavioral Approach
Behavior therapy was well suited to the Boulder
model because clinical psychology training was
designed to emphasize both the science and
practice.
The behavioral approach was well suited to the
social and political influences of the time. It was an
optimistic notion that we could create a more
perfect society using social engineering and
conditioning techniques.
The Behavioral Approach
There are various types of behavior therapy such as applied
behavioral analysis, social learning theory-based treatment
of Bandura and CBT.
Their commonality is that most problematic behavior is
learned and can be altered through the use of learning
principles.
Treatment methods are scientifically based procedures and
can be objectively used and evaluated.
The Cognitive-Behavioral Approach
became popular during the 1970s. Many
behavioral researchers and clinicians admitted
a number of significant limitations in their
model. The approach ignored the contributions
of thinking and attitudes in human behavior.
The Cognitive-Behavioral Approach
Albert Ellis’s Rational-Emotive Therapy;
Aaron Beck’s cognitive treatments for depression;
the cognitive restructuring work of M. Mahoney;
the stress inoculation work of Meichenbaum;
the self-efficacy work of Bandura
led the integration cognitive approaches with
behavioral approaches.
Aaron Beck (1921- )
The Cognitive-Behavioral Approach
Ellis’ REBT focuses on to alter the patient’s irrational beliefs
about themselves and others.
Beck’s cognitive approach focuses on to alter maladaptive
thought patterns and developing more adaptive ways of
thinking. Depressed people tend to view themselves, others,
and the world as more negative.
Meichenbaum’s self-instructional approach uses self-talk to
alter problematic thinking and behavior..
Their commonalities are
that learning and behavior are cognitively mediated by
attitudes and attributions.
that the role of the therapist is to serve as a coach and
educator in assisting the alteration of maladaptive
cognitive processes and behavior.
The Humanistic Approach
employed philosophy, existentialism, and
theories of human growth and potential.
It focused on the patient’s experience or
phenomenology.
It offered warmth, empathy, and unconditional
positive regard in psychotherapeutic
interactions.
The Humanistic Approach
During the 1950s and 1960s, the humanistic
approach gained common acceptance.
Psychodynamic and behavioral views perceived the
human nature as negative. The humanistic school
accepted the more optimistic and approval views.
The humanistic approach became known as the
third force following the psychodynamic and
behavioral approaches.
The Humanistic Approach
It was strongly influenced by philosophy and the
existential approach. The existential approach
became popular after World War I and in response
to Nazi Germany during World War II.
Kierkegaard, Nietzsche, Sartre, Buber, and
Heidegger were existantialists.
This approach focused on the meaning of life.
The Humanistic Approach
American psychologist Rollo May and psychiatrist Irvin
Yalom helped to popularize the existential approach to
humanistic therapy in the USA.
Psychoanalytic writers such as Hans Kohut and Otto
Kernberg have integrated some of the humanistic perspective
into their writing.
Carl Rogers, Abraham Maslow, Frederick Perls, Victor Frankl
contributed to the development of the humanistic
approaches to psychotherapy.
Their commonalities are
that humans are able to be consciously reflective and have the
ability to experience self-determination and freedom. Thus,
therapists must be able to fully understand a person’s perception.
that humans struggle toward growth and are not trying to
maintain homeostasis by satisfying various primitive needs and
conflicts.
Existantialists
 Sartre
Kierkegaard
Nietzsche
Their commonalities are
that defended a belief in free will and regarded
human behavior as not just a by-product of early
childhood experiences or only conditioned
responses to the external environment.
that is person-centered with maximum respect for the
individual and his or her experiences.
Carl Rogers (1902-1987)
The client-centered approach of
Carl Rogers became the most
influential humanistic therapy.
The approach emphasizes
empathy,
unconditional positive regard,
congruence,
intensive active listening, and
support to reach full human
potential.
The Family Systems Approaches
tend to use the whole family in understanding and
treating problematic feelings and behavior.
Prior to the 1950s, the family members of the identified
patient were left out of the treatment and not viewed
as potentially active agents of dysfunction and
recovery.
During the 1950s, 1960s, and 1970s, the family systems
approach became popular.
The Family Systems Approaches
Therapists observed that patient functioning often worsened
when the patient interacted with family members. Therefore,
all family members were treated together.
The family systems approach emerged from the Bateson
Project during the 1950s. Gregory Bateson, an anthropologist,
was interested in communication styles, collaborating with
Jay Haley to examine communication styles such as doublebind communication. Double-bind messages include
impossible-to-satisfy requests.
The Family Systems Approaches
Jay Haley later joined with Salvador Minuchin to develop the
structural family therapy model and focused on family
boundaries and generational hierarchies.
Haley, in the 1970s, founded the Washington Family Institute
where his wife, Cloe Madanes, developed the strategic
therapy model. Strategic therapy uses paradoxical intention.
In Europe, Maria Selvini-Palazoli and colleagues
founded the Milan Associates to treat families
confronted with anorexia nervosa in a family
member.
Murray Bowen used psychoanalytic theory in their
application of family therapy.
The Family Systems Approaches
Carl Whitaker and Virginia Satir focused on
experiential models.
Nathan Ackerman and Salvador Minuchin
developed structural family therapy and focused on
family boundaries and generational hierarchies.
The Family Systems Approaches
 While there are various types of family therapies,
commonalities are:
 a focus on the role of the whole family system in producing
and maintaining problematic behavior,
 communication patterns associated with family problems,and
 ongoing maladaptive relationship patterns among family
members.
 Intervention at the family level rather than at the individual
level became the goal of these treatment strategies.
Psychotropic Medication
Biological treatments and medications
such as opium, insulin, and electric
convulsive therapy (ECT) were used to
treat mental illnesses during the early
and mid part of the 20th century.
ECT
 Clinical Psychology Immediately after World War II
Boulder Conference in 1949, standards for doctoral
training, scientist-practitioner model.
Alternative psychotherapies rose to the
Psychodynamic Approach
Psychotropic Medication
In 1950s, the effective medications were developed to treat
severe disorders such as SCH and bipolar illness. It was by
accident.
In 1952, Jean Delay gave the chlorpromazine = Largactil to
patients. They found that schizophrenic patients
experienced fewer hallucinations and delusions.
Psychotropic Medication
Benzodiazepines (such as Diazem) were found in the
1960s to be effective in reducing anxiety.
The prophylactic use of neuroleptics increased the
possibility of community residence and decreased the
demand for hospitalization. There was a trend to
deinstitutionalize for schizophrenic patients.
The increasing use of medication to treat psychiatric
problems gave the leadership role physicians.
Psychotropic Medication
Today, about 20% to 30%
of all medications
prescribed are related to
depr and anx.
Psychologists obtained
prescription privileges in
Louisiana, New Mexico
and Guam.
Community Mental Health Movement
During the period of deinstitutionalization, patients
needed outpatient services to adjust to the society,
obtain employment, and cope with the stresses of life
and social demands. Interest in the prevention of
mental illness as well as the social factors that
contribute to mental illness— such as poverty,
homelessness, racism, unemployment, and divorce—
developed community mental health movement.
The community mental health clinics opened
throughout the USA. Psychologists provide a wide range
of professional services in these clinics.
The Integrative Approaches
After the explosion of new theories and
approaches during the 1950s, 1960s, and 1970s,
many researchers and clinicians felt dissatisfied
with one particular theory. Each school such as
behavioral, CBT, humanistic, family systems,
psychodynamic developed their own philosophy
or worldview.
The Integrative Approaches
Many psychologists felt dissatisfied with one
particular theory. During the late 1970s and early
1980s, many professionals sought to integrate the
best.
Research was unable to demonstrate that any one
treatment approach or theoretical orientation was
superior relative to the others. Majority of clinicians
identified themselves as being eclectic or
integrative.
The Integrative Approaches
Dollard and Miller (1950) tried to understand
psychodynamic concepts through behavioral or learning
theory language.
Jerome Frank examined the commonalities of various
methods and found that they all include instilling hope
in the patient, encouraging improved morale and
understanding of self and others, a healing setting (e.g.,
psychotherapy office), and supporting change outside of
the treatment environment.
The Integrative Approaches
Others focused on the nature of the professional
relationship as being a common curative factor in all
types of therapies.
The Biopsychosocial Approach
Since the 17th century and the influence of
Descartes and Newton, theories of health and
illness have tended to separate the mind from the
body. Western medicine view sickness as being
influenced either by biology, such as genetics and
neurochemical imbalances, or by the mind, such as
personality and interpersonal conflicts.
The Biopsychosocial Approach
During the last half of the 20th century,
advances in medicine, science, psychology,
sociology, ethnic and minority studies have
provided evidence for interactive
multidimensional influences on health and
illness.
The Biopsychosocial Approach
New discoveries in genetics and neurochemistry,
such as neuroimaging, have hardened the
contribution of biology to emotion and behavior.
The effectiveness of psychotropic medications
provided evidence to the biological influences
impacting behavior.
The new theories provided evidence to psychological and
social factors influencing health, illness, and behavior. The
community mental health movement demonstrated the
influence of social, cultural, and economic factors.
The Biopsychosocial Approach
emerged during the late 1970s. In 1977, George Engel
published a paper that proposed the biopsychosocial
approach as the model of understanding and
treating illness. The approach suggests that physical
and psychological problems are likely to have a
biological, psychological, and social element that
should be understood in order to provide effective
intervention strategies.
The Biopsychosocial Approach
The biological, psychological, and social aspects of
health and illness influence each other.
When designing treatment and prevention
interventions, an understanding of these interactions
should be taken into consideration.
The Vail Conference
A turning point in the training of clinical psychology
occurred during the 1973 Vail Conference.
The Conference aimed to discuss how training could
be altered to accommodate the changing needs of
both clinical psychology students and society.
The Vail Conference
In addition to the Boulder or scientist-practitioner
model, the Vail or scholar-practitioner model was
an alternative.
This model suggested that clinical training could
emphasize the delivery of professional psychological
services while minimizing research training. Graduate
training need not occur only in university psychology
departments but could also occur in professional
schools of psychology.
The Vail Conference
The Conference approved
the PsyD (or doctor of
psychology) degree as an
alternative to the PhD
degree.
Salt Lake City Conference
During 1987, the National Conference held another
meeting to examine how training models best fit the
needs of students, society, and the profession.
Salt Lake City Conference
This Conference approved the notion that all graduate
training in clinical psychology, regardless of the degree
(PhD or PsyD) or setting (university or professional
school), should include a core curriculum containing
courses such as research methods, statistics, professional
ethics, history and systems, psychological assessment,
and on the biological, social, cognitive, and individual
difference bases of behavior.
Salt Lake City Conference
The Conference stated that all APA accredited programs
should at least be affiliated with a regionally accredited
university. This measure was passed in order to maintain
better control over the professional schools. But, this
recommendation has been ignored. The majority of
professional schools of psychology are still not
associated with any university.
New training model
Clinical scientist model is a more research-oriented
and scientific approach to training relative to Boulder
and Vail models. It developed in the 1990s.
Michigan Conference on Postdoctoral
Training
The APA accredits and provides detailed guidelines for
graduate and internship training, no APA guidelines
have been provided for postdoctoral training.
The Michigan Conference developed guidelines and
plans for control and regulation of postdoctoral training.
Michigan Conference on Postdoctoral
Training
Recommendations included :
 the completion of APA accredited doctoral and
internship training programs prior to admission to
accredited postdoctoral training programs;
 at least two hours per week of face-to-face supervision
by a licensed psychologist; and
 a systematic evaluation mechanism for examining the
trainees.
The rise of Empirically Supported
Treatments
Empirically supported treatments are well-established
treatment approaches.
Standards for empirically supported treatments :
 They have received significant research support
demonstrating their efficacy using between- group
design or single-case design methods.
Empirically Supported Treatments
 Results must have demonstrated superiority to placebo
or other treatments.
 Experiments must have used enough subjects.
 They must have used treatment manuals.
 The effects must be found by two independent
researchers.
Empirically Supported Treatments
Examples:
 Exposure treatment: phobia, PTSD.
 CBT: headache, panic, bulimia, irritable bowel
syndrome
 Insight-oriented dynamic therapy: depression, marital
discord.
Evidence-based practice
Evidence-based practice attempts to integrate the best
available clinical research with quality clinical
expertise to help the unique individual seeking
professional services get his/her needs met.
Significant recent events:
 1970
 1973
 1980
 1981
 1982
 1985
 1987
 1987
DSM II published
Vail conference,
DSM III published
APA ethical standards revised
Health psychology defined
???????
DSM III-R published
Salt Lake City conference
Significant Recent Events
 1988
 1992
 1994
 2002
 2002
American Psychological Society founded
Michigan Conference
DMS IV published
APA ethics code revised
New Mexico allows psychologists
medication prescription authority
Present Status
Diversity in gender, culture, ethnicity, language, religion,
sexual orientation, physical ability and disability, and
the entire spectrum of individual differences has been
important for the practice.
Training itself is undergoing significant changes.
The gender distribution of clinical psychologists has
changed from being mostly men to being mostly
women.
Present Status
Economic factors in health care are altering the field.
Significant reductions in funding
Solo independent practice may become less attractive as
a career option in the future. Clinical psychology has
expanded beyond the mental health field into the
general health care and preventative health care fields.