The History And Development Of Clinical Psychology

Greek and Roman History of Clinical Psychology

In the ancient times, people thought mental illness to be a demonic possession or divine punishment. Since there was no evidence or logical reason found behind these diseases, treatments were introduced to help clear the body from any spirit that may have taken over the person.  Physicians fought against this view, giving physiological explanations for mental illness. People sought to magical or religious methods for cure which included spending the night in a temple. The ones suffering were either taken care of by their families or they were thrown out of their houses.

It wasn’t until Hippocrates (460 – 377 BC), who brought up the thought that mental illness was due to the imbalance of four bodily fluids or humour, which was the first scientific explanation to mental illness. Aristotle and Galen later on contributed to Hippocrates’ theory of humours.

Greek doctors did not differentiate between physical and mental disorders, and they were not able to diagnose cases from schizophrenia to cases as simple as depression. Back in those they were more concerned with externalising disorders such as ADHD, conduct disorder, etc. rather than internalising disorders such as depression and anxiety. The treatment that they introduced ranged from prayers to surgery. The practice of physical restraint was also included which is looked down upon in the present.

The people with illness were forced to give up on life without treatment. They were shunned, killed or imprisoned. The diseased were either allowed to roam the cities aimlessly or were forced to stay indoors.

References:

Burton, N. (2012). A brief history of psychiatry. Psychology today. Retrieved from

https://www.psychologytoday.com/blog/hide-and-seek/201206/brief-history-psychiatry

Beck, J. (2014). Diagnosing mental illness in ancient Greece and Rome. The Atlantic. Retrieved from

https://www.theatlantic.com/health/archive/2014/01/diagnosing-mental-illness-in-ancient-greece-and-rome/282856/

The History And Development Of Clinical Psychology

Psychotherapy

Psychotherapy or talk therapy involves a conversation with a trained therapist who helps the patient make sense of, understand and change what troubles them. There are three main types of psychotherapy: psychodynamic, behavioural and existential therapies.

According to psychodynamic therapy, conflicts within a person are the reason behind his/her mental illness. Conflicts may be in the form of unfulfilled desires of childhood or unresolved fears. In a psychodynamic therapy session, it is assumed that the therapist would understand the client’s intrapsychic conflicts better than the client and therefore the therapist illuminates the client so that he/she gains the same understanding. For psychodynamic therapy, emotional insight is the important benefit that the client derives from the therapy. Emotional insight is present when the client is able to understand his/her conflicts intellectually and the client’s distress reduces because of this.

In behavioural therapies, mental illness may be due to maladaptive learning of behaviours. Faulty learning, conditioning patterns and faulty thinking and beliefs are maladaptive behaviours that lead to abnormal behaviour. Psychodynamic therapy uses the methods of free association and interpretation of dreams to identify the root problem of the mental illness. The behavioural therapy sets up alternate behaviours for the faulty behaviours. In existential therapy, there is the use of unconditional positive regard and empathy that helps the client to acknowledge his/her mental illness. The therapist in a behavioural therapy finds out the faulty thinking patterns and behaviours of the client and chooses the appropriate behaviour and thought patterns that would be adaptive. According to behavioural therapy, the chief benefit of the therapy is to change the faulty behaviour and thinking patterns into adaptive ones.

In existential therapies, mental illness is considered to be the result of one’s meaning to life and existence. Feelings of loneliness, alienation, sense of usefulness, etc. are some of the reasons that lead to mental illness according to the existential therapy. Contrast to the other two therapies, in existential therapy the therapist merely provides a warm and empathetic relationship that assists the client to understand his/her problems. Personal growth is the prime benefit that a client arrives to in an existential therapy.

References:

Tripathi, R.C. (2006). Psychology. New Delhi : NCERT

British Psychoanalytic Council (2007). Making Sense of Psychotherapy and Psychoanalysis.

The History And Development Of Clinical Psychology

The Process of Cognitive Therapy

The end of all therapy is to find a way to resolve the conflicts that causes distress and leads to psychological disorders which prevents a person from living their life. Every therapy has a goal which is what both the therapist and the client tries to achieve. Therapies differ in their way of reaching towards it. Each therapy has a specific way through which they would like to achieve the desired outcome. In cognitive therapy, the psychological disorder is resolved by changing the distorted and irrational thoughts and beliefs.

To be successful in the process of changing a thought or a belief, both the therapist and the client should have a clear understanding of why that irrational thought or belief manifested or developed in the first place. To do that, the therapist should analyse and question the client’s past and probe and explore the event which lead to the irrational belief. This process of searching and analysing can be accomplished by a lot of different ways. It can be done through interviews, questionnaires, observation methods etc. however like all therapies, the therapist should first establish a rapport with the client so that a trusting and warm and confiding environment is created such that the client doesn’t hide or obscure the truth. The questions should be asked in a gentle, non-threatening, non-directive manner such that the client is not made to feel uncomfortable and frightened. The questions should make the client think in a positive manner that could facilitate the change of irrational thoughts and beliefs to rational thoughts and beliefs.

According to Aaron beck’s theory, the questions should make the client think in a direction opposite to that of the negative automatic thoughts whereby s/he gains insight into the nature of her/his dysfunctional schemas, and is able to alter her/his cognitive structures. The aim of the therapy is to achieve this cognitive restructuring which, in turn, reduces anxiety and depression. 

According to Albert Ellis theory, the questions make the client to think deeper into her/his assumptions about life and problems. Gradually the client can change the irrational beliefs by making a change in her/his philosophy about life. The rational belief system replaces the irrational belief system and there is a reduction in psychological distress.

The History And Development Of Clinical Psychology

Cognitive Theories in Clinical Psychology

Cognitive theories explain the cause, antecedent behaviour, goal of therapy, therapeutic relationship and other factors involving therapy through the principles of cognitive theory/approach. Cognitive approach is under behaviour therapy but while behaviour therapy focuses more on the client’s behaviour, cognitive therapy focuses more on the client’s thinking patterns. Cognitive therapies locate the cause of psychological distress in irrational thoughts and beliefs. Unlike traditional behavioural therapists, cognitive therapists pay considerable attention to people’s beliefs about themselves and altering a negative self-image is often a central part of therapy.

There are two major proponents of cognitive therapy. They are Aaron Beck and Albert Ellis.

Aaron beck said that disorders manifest out of core schemas or systems that a child develops through the experience that he is provided with. His theory of psychological distress characterised by anxiety or depression, states that childhood experiences provided by the family and society develop core schemas or systems, which include beliefs and action patterns in the individual. These schemas in a way act as a precursor to the cognitive distortions that a child develops. For example, a child who is been neglected by his parents develop a core schema that he is not wanted. These develop into negative thinking and beliefs triggered by a specific incident. This affects the child’s social as well as personal life and development. Aaron beck talked about cognitive distortions. He said that negative thoughts are characterised by cognitive distortions. Cognitive distortions are ways of thinking which are general in nature but which distort the reality in a negative manner. These patterns of thought are called dysfunctional cognitive structures. They lead to errors of cognition about the social reality. This later lead to feelings of anxiety and depression.

Albert Ellis introduced a therapy under cognitive approach called RATIONAL EMOTIVE THERAPY. The central thesis of the therapy is that irrational beliefs mediate between the antecedent events and their consequences. The client undergoes antecedent-belief-consequence analysis. Through this analysis, antecedent events and factors which lead to the cause of the psychological distress is noted down. Irrational beliefs that distorts the present reality which arises out of antecedent cause is known. These irrational beliefs and thought process leads to a consequence which is considered to be deviating and dysfunctional. distorted perception of the antecedent event due to the irrational belief leads to the consequence, i.e. negative emotions and behaviours. Hence diagnosed as psychological disorder.

The History And Development Of Clinical Psychology

Cognitive Approach in Clinical Psychology

Since the early 1950s psychology has seen many significant developments. On the theoretical side, one of the most dramatic has been the decline of behaviourism and the rise of cognitive psychology, whereas on the practical side there has been an enormous expansion in the clinical applications of psychological knowledge. Much of the subject matter of clinical applications of psychology, such as distressing thoughts and memories, delusions and fixed ideas, is of course cognitive in nature. Cognitive theories are not new but it is only comparatively recently that they have come to play an important role in clinical psychology, backed up by the findings of systematic empirical research.

Cognitive approach or its significance in clinical psychology should first begin with the understanding of what cognitive is and on what basis it was formed.

Cognitive encompasses all acts or processes of knowing, perceiving etc. it relates to the mental processes of perception, memory, judgement and reasoning, as contrasted with emotional and volitional(behavioural) processes. Psychological processes involved in acquisition and understanding of knowledge, formation of beliefs and attitudes and decision making and problem making. Cognition includes the conscious and unconscious, concrete and abstract as well as intuitive thoughts. It involves application of past knowledge and generating new knowledge.

Now that we have understood what cognition is, cognitive approach is the explanation given to any phenomenon through the lens of cognitive processes.

Clinical psychology is a broad branch of psychology that focuses on diagnosing and treating mental, emotional, and behavioural disorders. It also deals with identification and resolving of disorders. Cognitive approach in clinical psychology explains disorders in the perspective of cognition.

The task of the various branches of cognitive psychology is to explain how knowledge is acquired, how it is represented internally, and integrated with the existing information and what kind of knowledge affect people’s feelings and behaviour. The task of the clinical psychologist is to apply this understanding to the enhancement of human potential and to the alleviation of suffering.

Cognitive approach says that people exhibit deviating, dysfunctional behaviour because of faulty thinking. The disorders manifest or continue to prolong because there is distortion in their thinking that prevents people from living life without any difficulties.

We all face cognitive distortion in our life at some moment in our life. But it becomes a disorder when that distortion is never resolved and becomes a central part in which a person thinks or looks at the world around him. For example, we all have this thought at some point in our life that we are incapable of doing something or when we think that we are not loved. This is cognitive distortion because we have distorted the reality into something which might not be true. It affects us physically, behaviourally, emotionally. This is normal. But It becomes a disorder when we are unable to come out of that thinking. We continue to think that way. Not only does it affect us physically, emotionally etc. it also affects psychologically i.e, it starts to affect other facets of life too.

Cognitive theory in clinical psychology tries to understand and analyse these faulty thinking patterns and find a way to resolve them. The client who is suffering from a psychological disorder undergoes therapy wherein his faulty thinking is changed.

The History And Development Of Clinical Psychology

Defence Mechanisms in Mental Disorders

Defence mechanisms are unconscious psychological strategies developed by individuals against anxiety-provoking thoughts, ideas and memories. Anxiety arises when a person has unacceptable or uncomfortable thoughts, and he or she understandably seeks to reduce or eliminate it. Defence mechanisms as proposed by Sigmund Freud are ways of dealing with anxiety and they often distort or misrepresent reality. They form a major aspect of Freud’s psychoanalytic theory. Some of them are as follows:

1. Repression: This is the fundamental defence mechanism, and usually occurs in case of trauma. It means the burying of traumatic memories or ideas so that they are no longer available to the conscious mind.

2. Projection: Deals with anxiety causing thoughts by attributing them to someone or something   other than oneself.

3. Reaction Formation: Doing the opposite of doing what one wishes to do, because the original wish causes discomfort, usually due to being socially unacceptable.

4.Identification: Occurs as a means of dealing with moral or emotional anxiety by emulating the behaviour of another person, and adopting their values and beliefs.

5. Rationalization: Coming up with a rational, logical but false reason for a failure or shortcoming.

6. Denial: Refusal or failure to accept one’s feelings or actions to avoid damage to oneself’s ego.

7. Regression: Reversion to a behaviour or thinking that was present at an earlier age.

8. Undoing: When we commit acts to appease guilt arising from a past wrongdoing, or what is perceived by an individual as such.

The psychodynamic approach suggests that defence mechanisms are often involved in many mental disorders. For example, regression, denial, reaction formation and undoing are involved in post traumatic stress disorder. PTSD also very often involves repression of trauma, which may reactivate previously repressed and unresolved thoughts, thus increasing anxiety. This coupled with regression results in anhedonia (inability to experience pleasure from generally pleasurable activities), depersonalization (feeling detached from one’s own self and thoughts) and derealization (viewing the external world as strangely detached).

Research also suggests that reaction formation is significantly associated with obsessive-compulsive disorders. Depression ,however, enlists a huge number of defence mechanisms: passive aggression (indirect expression of hostility, because direct expression is considered unacceptable), denial, idealization, devaluation, projection, identification with aggressor and many others.

Defence mechanisms are often listed as symptoms of various mental disorders. Therapeutic techniques usually seek to eliminate them when they manifest in harmful ways, to cure the individual of the disorder affecting them. Therefore, while defence mechanisms can extremely beneficial, they can also be equally detrimental to our mental well-being.

REFERENCES

1. Hergenhahn, B. R., & Henley, T. (2013). An introduction to the history of psychology. U.S.A: Hague.

2. Posttraumatic Stress Disorder: Psychodynamic Explanations. Retrieved from: http://www.whatispsychology.biz/posttraumatic-stress-disorder-psychodynamic-explanations

3. Defense Mechanisms. Retrieved from: https://www.simplypsychology.org/defense-mechanisms.html

4. 31 psychological defense mechanisms explained. Retrieved from: https://www.psychologistworld.com/freud/defence-mechanisms-list

The History And Development Of Clinical Psychology

Clinical Significance of Psychoanalysis

Psychoanalysis is a therapeutic method which focuses on the unconscious mind and repressed memories of individuals and their influence on mental health. Psychoanalytic theory was first proposed by Sigmund Freud. Psychoanalysis functions on the assumptions that our behaviour and personality are strongly affected by unconscious motives and rooted in our childhood experiences.

Though Freud was indubitably the most influential advocate of psychoanalysis, it was his friend and mentor, Dr Joseph Bruer who first employed the method to treat a patient. In 1880, he treated a woman anonymously referred to as Anna. O, who was diagnosed with hysteria. She exhibited symptoms such as memory loss, mental disorientation, disturbances in vision and hearing and constant squinting. Bruer discovered that Anna’s last symptom was a result of her father’s death. When he had once asked her what time it was as she was sitting by his bedside, she had to squint to look at the clock because of being teary-eyed. He found that most of Anna’s symptoms were caused by ‘pathogenic memories’ that were usually traumatic and repressed. Once he traced each symtom to its pathogenic memory, however, the symptom disappeared. After being treated for two years, Anna went on to eventually become a leader in the European feminist movement. Thus, psychoanalysis began with clinical treatment.

Psychoanalytic theory says that when a traumatic memory or idea becomes too difficult for a person to deal with, it is repressed; the person is no longer conscious of its existence. Repressed memories cause psychological symptoms, which can be cured by making the memories consciously available to the patient again. Freud termed the method he used for their retrieval free association.

Free association is a process in which a patient is asked to share his/her thoughts, memories, feelings and whatever comes to mind truthfully and freely, irrespective of their meaningfulness or relevance. They are interpreted by a psychoanalyst who discovers underlying meanings and connections and often steers the patient’s thought processes to help him/her discover previously repressed ideas and deal with them carefully. The goal, then, is to make the unconscious conscious.

Other methods such as dream analysis, which are considered to be symbolic expressions of repressed thoughts and wishes, and interpretation of parapraxes (minor errors in daily life fuelled by unconscious motives) are also highly popular methods of gaining access to a person’s unconscious mind.  The psychoanalytic method is extremely useful in treating mental disorders such as depression, general anxiety disorders, obsessive-compulsive disorders and post traumatic stress disorders. In spite of being highly criticized by some, psychoanalysis prevails and continues to be highly influential in the field of psychology.

References:

1. Hergenhahn, B. R., & Henley, T. (2013). An introduction to the history of psychology.U.S.A: Hague.

2. Psychoanalysis. Retrieved from https://www.simplypsychology.org/psychoanalysis.html#clin

The History And Development Of Clinical Psychology

Humanism’s Client Centered Therapy

Client-centred therapy is a type of therapy that falls under the humanistic approach. It requires the client to explore his/her own feelings while the therapist provides a warm and non-judgemental environment for him/her to do so. Carl Rogers is the humanistic psychologist that developed client-centred therapy and for that reason it is also known as Rogerian therapy.

The nature of the relationship between therapist and client in client-centred therapy is quite different from the therapist-client relationship in other therapies. It is unique. In the discussed therapy, both therapist and client are considered to be equal. This is a contrast to the usual therapist helping client arrangement. In client-centred therapy, the therapist must possess the following qualities:

  1. Empathy
  2. Warmth
  3. Unconditional positive regard
  4. Genuineness

There are no specific techniques that client-centred therapists use.

The concept of self or self-concept is the core of Rogerian therapy. It can be defined as the idea one has about themselves. References to it are made whenever we use the words “I” or “me”.

The present is what matters according to this therapy and trying to resolve past experiences is not beneficial to the client. For this reason, the therapist focuses on assisting the client with personal growth instead of identifying anxiety-inducing past experiences as a psychoanalyst would. When a positive, healthy attitude is inculcated in the client, then he/she can move forward. This is brought about by reflection of the client’s feelings. This means that what he/she says is paraphrased by the therapist and clarified to enhance the meaning of the statement.

This approach is frequently deemed as unscientific by critics.

References:

McLeod, S. (2008). Person centred therapy. Simply Psychology. Retrieved from https://www.simplypsychology.org/client-centred-therapy.html

Carl Rogers’ Client Centered Therapy: Definition, Techniques and Goals. (n.d.). Retrieved from https://positivepsychologyprogram.com/client-centered-therapy/

The History And Development Of Clinical Psychology

Clinical Psychology in Humanism

Within the broad subject that is psychology, the humanistic approach is a perspective that concentrates on the individual themselves. It sees humans as inherently good. This is marginally yet distinctly different from the other approaches to psychology that choose specific aspects of the individual to study. For example, behaviourism focuses on observable behaviour and psychodynamic focuses on the unconscious.

The humanistic approach is said to be made into a formal branch of psychology by Abraham Maslow. It was developed in opposition to the behaviouristic and psychodynamic approaches. This perspective was radically different in the way that it deviated from the others’ deterministic method of explaining human behaviour. It came to be known as third force psychology.

Humanistic psychologists assign the reason for psychological distress or abnormality as the inability to be the true self or the feelings of loneliness and estrangement. Self-actualisation is seen as the ultimate goal of all human beings in humanism. When this need to self-actualise is inhibited, psychological distress is elicited. This means that abnormality occurs when there are obstacles in the process of the alignment of the real self and ideal self. This notion provides a stark contrast with the otherwise passive-patient, disease centric view of mental illness.

The power of the patient was greatly emphasised in humanistic therapy. Instead of the psychologist playing a key role in the alleviation of a mental illness, the patients were encouraged to help themselves (with the guidance of a psychologist). They were urged to grow out of the distorted mind sets they had, thereby relieving the pain they were inflicting upon themselves.

Although humanistic psychologists are few in present day times, the school’s contributions permeate many of the other approaches. They broadened the scope of psychology in the sense that they advocated the study of all aspects of humans and not only those which are measurable.

References:

McLeod, S. (2007). Humanism. Simply Psychology. Retrieved from https://www.simplypsychology.org/humanistic.html

Sammons, A. (n.d.). The humanistic approach: The basics. Retrieved from http://www.psychlotron.org.uk/newResources/approaches/AS_AQB_approaches_HumanisticBasics.pdf

The History And Development Of Clinical Psychology

Cognitive Behavioural Therapy

Behavior therapies on its own, helps in making an individual’s feelings and emotions more positive by helping them modify their behavior. Cognitive therapy meanwhile, focuses on altering an individual’s thought processes to help them improve their emotional state. When these two schools are combined to form a more action-oriented method of psychotherapy, the result is cognitive behavioral therapy, commonly known as CBT. It concentrates over the relationship between beliefs, thoughts, and feelings, and subsequent behavior patterns and actions to result in rational thinking. 

Cognitive behavioral therapy is different from other kinds of therapies through the following factors:

  1. It is based on cognitive restructuring (changing thinking structure) and behavioral activation (overcoming obstacles).
  2. It focuses on specific problems and tries to understand the roots of the problem which are the individual’s core beliefs.
  3. It is goal oriented, where patients fix goals of certain time periods to achieve with help from their therapists.
  4. CBT is educational where the patient learns problem solving , coping skills and monitoring negative thoughts.
  5. Patients of CBT play an active role in their own therapy by maintaining journals and doing homework between sessions.
  6. It uses a variety of strategies to deal with issues such as the Socratic questioning method, role playing, and imagery and guided experiments.
  7. CBT is constrained by time and lasts for about 16 weeks.

Cognitive behavioral therapy involves a group of therapies that have similar therapeutic methodologies.

A few major types of therapies include:

  1. Rational emotive behavior therapy
  2. Cognitive therapy
  3. Dialectical behavior therapy

Cognitive behavior therapy is an effective treatment for depression, anxiety, Post Traumatic Stress Disorder, substance abuse, eating disorders and borderline personality disorders.