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The History of Clinical Psychology

by: Sheldon J. Korchin

(Short Outline)

The Origins of Clinical Psychology

Clinical psychology is heir to both the psychometric and the dynamic traditions of
Psychology (Korchin,1976; Watson, 1953). In its first phase, the psychometric tradition, with its
emphasis on measurement and individual differences in mental functioning dominated. The earliest
clinician were mental testers. The dynamic tradition, focusing on motivation, adaptation, an
personality change, came into greater prominence in the more recent history in the field, as
clinician’s interests have shifted toward personality dynamics, development, and psychotherapy.

Both the psychometric and the dynamic orientation were anchored in 19th century
European psychology, but they transplanted readily and flourished in the intellectual climate of
America in the 1890s. The functionalist and pragmatic themes in the American psychology
provided a particularly receptive soil for clinical and other applied psychologies. Americans had
little patience for either a psychology that dissects into minute detail the structures if the mind
(which, said the great William James, intrigues him as much as counting the rocks on his Vermont
farm) or for a psychology that speculates grandly about the ultimate nature of the human mind.
Concerned with what could be measured and studied empirically, American psychology had an
early and continuing concern with altering and improving human functioning .

The Psychometric Tradition

Not long after the pioneers of experimental psychology had developed techniques for
measuring psychological processes, in the hope of discovering general psychological laws, such
techniques were being used to compare individuals.
• Sir Francis Galton’s studies of differences among people laid the ground work of
differential psychology. By 1890, James McKeen Cattell had coined the terms “mental tests”. Within
short order, statistical procedures evolved for the development and standardization of tests of
psychological functions, in many realms.
• An event of considerable importance in this story occurred in 1904 when the Minister of
Public Instruction of Paris sought the help of Alfred Binet in order to distinguish mentally
defective children who should be taught in special rather than regular classes. The resulting
of Binet-Simon scale included tests of attention, memory, imagination, motor skills,
comprehension, and other psychological functions.
• Some years later, the German psychologist William Stern suggested that Binet’s “mental
age” scores be evaluated in terms of a child’s chronological age in order to achieve a stable
“intelligence quotient” (IQ).
• Through successive revisions, notably by Lewis Terman in the United States, the present
Stanford-Binet evolved. For many years, a major function of clinical psychologists was to
test children and report a Stanford-Binet IQ. By the 1920s and continuing through to the
present, arguments raged over the nature of intelligence, the constancy of the IQ, racial and
ethnic differences in IQ scores, culture- bias in test items and standardization, and kindred
issues.
• Lightner Witmer might be thought as of the father of clinical psychology (Reisman
1981). He was a student of James MacKeen Cattell and took his doctorate with Cattell’s own
teacher, the great Wilhelm Wundt of Leipzig. Using the test and laboratory procedures of his
time, Witmer studied children with school and learning problems. He was the first to use
the term “clinical psychology” and to describe the “clinical method in psychology”.
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• According to his friend Joseph Collins, in a 1896 talk before the American Psychological
• Association, Witmer pointed out that “clinical psychology is derived from the results of
an examination of many human beings, one at a time, and the analytic method of
discriminating mental abilities and defects develops an ordered classification of observed
behavior, by means of postanalytic generalization.” He put forth the claim that the
psychological clinic is an institution for social and public service, for original research and
for the instruction of students in “psychological orthogenics which includes vocational,
educational, correctional, hygienic, industrial, and social guidance.”

The Dynamic Tradition

In the same era that Catell, Binet, and Witmer were adapting procedures of the
experimental laboratories for clinical testing and studies of individual differences, students of
abnormal behavior were developing core ideas about motivation, psychopathology, and
psychotherapy; their ideas were to have a profound effect on clinical psychology and psychiatry.
Charcot, Janet, and other French psychopathologists were studying hypnosis, dissociation, and
hysteria, and laying the groundwork for the investigation of conflict in the unconscious as well as
the conscious mind. Influenced by them, Feud moved on to what still remains the most extensive
and coherent theory of motivation and personality disturbance. Freud’s through going psychic
determinism, attention to early childhood, and conceptualization of unconscious processes
profoundly altered psychology. In 1909, William James was to say: “The future of psychology
belongs to your work.” Although he gained a loyal, if small, group of followers, Freud’s writings did
not greatly affect the mainstream of European psychology and psychiatry for some years to come.

Freud’s influence on American psychology was greatly facilitated by two giants of American
academic psychology: G. Stanley Hall and William James. James was a man of broad and rich
interests, touching both the scientific and humanistic aspects of psychology. James’ own
commitment to advancing human well-being later emerged in his support of Clifford Beers’ crusade
for better conditions for psychiatric inpatients, which he knew well through first-hand experience.

G. Stanley Hall was similarly influential in the early decades of American psychology. He
wrote about developmental processes, sexuality, and adolescence. He encouraged clinical practice
and research, stimulated the development of psychological tests, and founded journals that would
provide outlets for students of abnormal behavior, social processes, and developmental psychology.

Carl Jung gave a research report on his studies using word association as method of
discovering unconscious complexes. Along with Freud’s analysis of dreams, this was an important
forerunner of projective testing. The use of projective techniques in personality and clinical
assessment represents a major confluence of the dynamic and psychometric traditions in American
clinical psychology, although it was not to emerge for almost 30 years.

From Witmer to World War II

By 1914, there were 20 psychological clinics on university campuses (Watson, 1953).

Psychologists moved into mental hospitals and clinics and into special settings for the mentally
retarded and physically handicapped. Considerable research was done in hospitals on the
psychological functioning of psychotics, using laboratory techniques. Developing, standardizing,
and using psychological tests were the major occupation of psychologists. In clinical centers, some
became “mental testers”, reporting test findings to medical superiors. Few held doctorates in
psychology.

The First World War accelerated the growth of clinical psychology. The military faced the
difficult task of evaluating the abilities of large numbers of men so that they could be placed in the
most suitable jobs. A number of psychologists, including leaders of experimental psychology, took
on the challenge and developed group intelligence tests. The Army Alpha was a verbal test sampling
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such abilities as vocabulary, arithmetic and judgment. Paralleling it was the Army Beta, which was
nonverbal and intended for illiterate or non-English –speaking soldiers. Robert S. Woodworth’s
Psychometric Inventory (more delicately labeled “Personal Data Sheet” on the form given to the
men) screened soldiers with emotional problems.

The Future of Clinical/Abnormal Psychology:

Psychology as an Autonomous Profession

Psychology has become, in fair measure, an autonomous, self-regulating profession. There

are standards and accreditation procedures for graduate education and internships, licensing laws
in all states, diplomatic examinations, and ethical codes for clinical practice and research, all of
which contribute to higher standards of training and practice to the ultimate benefit of the public.
However, danger lies in such regulation becoming bureaucratized and serving, ultimately, the guild
interests of already established psychologists. The doctorate has been established s the appropriate
degree for fully independent professional functioning, but this leaves uncertain how subdoctoral
clinicians and nonprofessional workers can make their contribution. While legislated standards,
licenses, accreditation, and the like can contribute to better practice, they can also lead to the
rigidification of a profession.

New Models of Clinical Training

At Boulder in 1949, the scientist-professional model of the clinician, with a Ph.D. from a
university, was established. The “Boulder model” was reaffirmed at conferences in Miami in 1958
and Chicago in 1965, although there was growing pressure for legitimizing more purely
professional training, perhaps leading to a professional degree, either in new settings within
traditional universities or in free-standing professional schools. At the Vail Conference of 1973, the
concept of “”professional” in addition t “scientist-professional” clinician was approved. In that era, a
number of new programs and alternative institutions evolved. As of now, in California at least, far
more clinicians are being trained in professional schools than in traditional university programs.
Many defenders of the Boulder idea are deeply concerned that the professional school movement
will lead to a kind of Gresham’s Law in clinical psychology. Since the professional schools tend to
value research than Boulder programs, there is particular fear that a large part of the new
generation of clinicians will lack the interest and skills to contribute to new knowledge or even to
self-critical in evaluating their own practice.

Serving a More Diverse Clientele in More Diverse Ways

The human problems with which clinicians now deal range from the enduring and grossly
disabling to the minor problems of life. Some reflect medical conditions, others distortions of
psychological development and personal experience, and still others relate directly to the stresses
of social life. Correspondingly, but not in any one-to-one-way, interventions range from drugs to the
many forms of individual therapy, family therapy, group therapy, to social and community
interventions. The range of patients served includes children, students, adults, the aged, workers,
and executives, the poor and the racial minorities as well as the affluent and educated, the
physically disabled, mentally retarded, brain-damaged, and medically ill, as well as those with more
strictly psychological problems. Not least, the settings in which clinicians work include schools and
universities, community agencies and organizations, and streets and homes as well as clinics and
hospitals. The opportunity to serve has greatly increased, but also the need to understand more
diverse problems, in more varied settings.
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Conceptual Frameworks for Clinical Intervention

Another face of the growing complexity of the clinician’s world is revealed by the
range of conceptual frameworks within which interventions are done, including those of biological
psychiatry, psychoanalytic, behavioral, and humanistic/existential psychologies, and social,
organizational, and community psychology. Herink has recently estimated that one choose from
among 250 different psychotherapies, each of which is endorsed enthusiastically by at least its
founder, a loyal band of followers, and a number of satisfied customers. Although there has been a
gratifying increase in well-designed research studies evaluating therapeutic outcome, there is yet
little conclusive evidence of the value of one therapeutic system over another. Moreover, serious
question is being raised as to whether all or most therapies are effective in terms of properties they
have in common rather than in terms of those qualities that distinguish them. With this recognition,
there has been a serious movement toward rapprochement among contending therapeutic systems,
with the possibility that the overall effectiveness of therapy increased by including elements from
different systems. This trend is also reflected in the greater willingness of clinicians to call
themselves “eclectic” rather than affiliated from any school.

Specialization

These many trends support the simple proposition that clinicians will function in
any many modes in the future, instead of one speciality, there will be a family of clinical
psychologies. The new clinician will be more of a specialist and less of a generalist, although I would
hope, with enough breadth and wisdom not to deserve the jibe that “a specialist is one who knows
everything about his field except its relative unimportance.” Traditionally, as we have seen, the
work of the clinician consisted of assessment, therapy, and research in either academic or
psychiatric settings. There is no end of possible jobs, including:
1. Medical psychologist working with patients at the hospitals
2. Health psychologist, working in such areas as stress management or
smoking control
3. Child clinician
4. Gerontological clinician, working with problems of the aged
5. Private practice psychotherapist
6. Community psychologist
7. Research clinical psychologist
8. Evaluation researcher
9. Consultant to school or industry, among others

The development of new specialties presents challenging new opportunities for service
and for gratifying careers. At the same time there is the danger of fragmentation of the broader
field. Obviously, to do of these jobs requires special knowledge and training, but is there a core of
the parent field of clinical psychology that should be incorporated in training of all these
specialists? Curiously, this is a rephrasing of a question of 1947: Is there a core of general
psychology that should be included in the education of all clinical psychologists? There was no
simple answer then, nor is there one now. From a personal standpoint, all of these trends highlight
the exciting state of clinical psychology today and the challenges in its future. With so many choices,
so much diversity, and change so rapid, my own inclination is to argue for the traditional virtues
embodied in the scientist-professional concept with the blend of understanding and helping that
has made clinical psychology unique. There is room and need for competent practitioners of course,
but even as Shakow noted in 1965, the greater need is for research that can guide future clinical
practice.