Lecture 9 Flashcards
How does academic psychology feel about clinical psychology?
Where did the idea of psychology as a therapy come from?
There has always been tension between clinical and academic psychology.
The idea of a psychological form of therapy comes from neurology, not psychology. Transfers to psychiatry. When Freud and Charcot were starting therapy, psychiatrists were mostly caring for very sick people and were not able to use talking therapies (or were not at this time). Hence, at first psychiatrists did not do psychotherapy but they gradually did take it over from neurology (Jung was a psychiatrist). Psychologists had a subordinate role and were mainly hired to administer tests.
In the 40s and 50s it leaked into psychology. In psychology, there was a clinical practise before that but it was more targeted towards children with behavioural problems.
Where was the first clinic in psychology?
Was it in a hosptial and why?
What was its purpose?
Who was the director and what is his connection to the APA?
The first clinic to be founded was in 1896. This was at the start of psychology and was under the movement that James was trying to give psychology; make it practical. And so American psychologists at this time looked favourably on applications. The first clinic was not associated with a hospital, initially doctors wanted to keep a hold on psychological treatments. So the clinic is associated with UPenn. The mission was to help kids with behavioural and learning problems. Was under the direction of Lightner Witmer who alongside Hall and Catell was a founder of the APA. It was important from the start but it did not go well at the start.
20 years later had it spread much?
Why or why not?
20 years later, in 1914 there is only 20 clinics in the USA. A major issue is the lack of support from Academic Psychology. They don’t like clinicians and want to keep control of the department. They also wanted psychology to be a science and clinical psychology is not fully scientific, they worried they would make them look bad. There was also an issue with medical colleagues. Doctors wanted treating anyone to be their exclusive domain. Academic psychologists do not want to pick fights with them. It is not an easy time for clinical psychologists. Witmer quit the APA for those reasons.
When was the first clinic a Harvard founded?
Who was the psychologist that helped it and was he a clinician?
The first clinic at Harvard was founded in 1927 (and saved by Gordon Allport). Prince and Murray here did more than just treat children. At this clinic, there was psychanalytic practises too. The medical profession disapproved. The department of psychology also did not like it. It survived.
What happened in 1921?
In 1921 the academics kick all the clinicians out of the APA. In parallel, the clinicians continue to work. Witmer in this period, used the term clinical psychology to refer to the branch of psychology applying psychological knowledge too the assessment and treatment of mental disorders. Witmer took a long time to choose the term. Chose clinical because of its medical connotations.
What did Whitmer call this branch of applied psychology and what is the definition?
clinical psychology to refer to the branch of psychology applying psychological knowledge too the assessment and treatment of mental disorders. Witmer took a long time to choose the term. Chose clinical because of its medical connotations.
How did WW1, WW, the Korean war and the Vietnam war help Clinical psychology?
What was important at each stage?
After WW1, soldiers get shell shock (PTSD). The army wants to predict who will get it and so they design tests. Woodworth helps. At the beginning clinical psychologists are really associated with psychological tests. Eventually, they start to do psychoanalysis (therapy). In WW2 you want to predict who is vulnerable AND you want to be able to treat them too. Finally, Korea and Vietnam, psychologists were very involved as there was much trauma.
What changed in the 1940s? Were clinicians happy with psychoanalysis?
In the 1940s things changed. A lot of clinicians were unsatisfied with psychoanalysis. It was long and inefficient. There is also something semi rude about this. The therapist is superior to the patient and also, uninterested in manifest content. They want the latent content. This was irritating for patients. This context led to Carl Rogers’ client focused therapy.
According to Rogers, what are the three core conditions?
According to Rodgers, the therapist must:
- Show unconditional positive regard
- Show empathetic understanding (very different from analysing) – listening to what they are saying not seeing something they are not
- Congruence (Genuineness)
Why were the 3 conditions of Rogers clever?
On one hand, it is a reaction vs. psychoanalysis but on the other, it is strategic to deal with the medical profession. These three things are not related at all to medical knowledge. Hence, you do not need medical knowledge to be a therapist, just to have these three things. This helped psychotherapy to find its place among medicine.
Why was Rogers idea well timed?
The reason why Rogers really helped clinical psychology is that he proposed it just before the rise of the antipsychiatry movement. This arose after WW2 and was associated with the counterculture. The powers in place do not always do what is best for the population. Started to question psychiatry. It was pretty awful at this time.
What horrendus treatments was psychiatry using at this time?
two
Two examples of treatments were frontal lobotomy and ECT. The Lobotomy’s creator Egas Monitz got a Nobel prize. Made it very popular; seemed to work, patients were calmer than lobotomies and it was really easy to do. Monitz bragged that he could teach it to a doctor in an hour. Disconnect the white matter of the frontal lobe from the rest of the brain. The patients physically recovered (not dangerous) but they were vegetable like. In the 1950s approximately 20,0000 lobotomies were performed per year. 60% were women. There were different intensities but in all cases, this is very invasive. Gradually, this was replaced by antipsychotic drugs in the 50s and 60s.
ECT induced electric seizures with electric currents. You can do this more than once. It is still used in select cases, seems to work. We do not know why but is used with success in severe depression. But in the 50s and 60s it was used widely with no empirical support to its use.
Describe the MKUltra experiments at McGill.
Who funded it?
Who was the man responsible?
What is Psychic Driving?
How did he do this?
At McGill in the 50s and 60s, the CIA funded project MKUltra at McGill under the supervision of Dr. Cameron at the Allen Memorial institute. MKUltra funded research in about a dozen universities in North America. It was secret, they did not come to Dr. Allen with a wallet of money, they had a cover organisation that looked like a public funding organisation. We do not know if Cameron knew it was the CIA or not. He was thinking this would help patients in the long run; that this could lead to breakthroughs in research. He thought he was doing good and did not care where the money came from possibly.
The CIA was financing this because the USA was in the cold war. There could have been areal 3rd world war (e.g., the Cuban missile crisis). The CIA wants to develop new interrogation techniques. Can you get a soviet spy to talk? The Manchurian Candidate is close to the MKUltra experiments. The idea was how can you use psychiatry to brainwash people.
Cameron came up with psychic driving. His hypothesis was that schizophrenia was caused by maladaptive learning. Maybe if we could erase their memory, we can sure them (reprogramming their psyche). This was his psychic driving hypothesis; like a control + alt + delete on their brain. Very extreme. The language is interesting “maladaptive” behaviourism “erase and restart” computer analogies.
Small amounts of ECGs and no lobotomies. Mostly drug induced comas for weeks or months. While they were in a coma, he would play tapes of noises or statements repetitively. Trying to reprogram the patients. The worst thing was that the patients did not consent. Typically, they were taking in at the hospital for minor things like post partum depression or small anxiety. They could be stuck in the hospital for years.
Why are Cameron’s actions shocking?
Cameron was not a rogue doctor. He was the establishment. During this period, he was elected as the first chairman of the World Psychiatric Association then the American and Canadian psychiatric association.
How did antipsychiatry help clinical psychology?
Frontal Lobotamies, ECT and MKUltra prompted antipsychiatry. This helped clinical psychology as they could paint themselves as much more human and caring.
Outline the Rosenhan experiment.
Another brick in the wall of antipsychiatry was the paper by Rosenhan Experiment (1973): on being sane in insane places. The prof and researchers entered a psychiatric clinic saying they heard voices until they were admitted. And then when they got there, they started to act normal. How long before they were released? 7-52 days. All of them were discharged with schizophrenia in remission diagnoses (labelled as mentally ill). Made a lot of noise, questions the validity of those psychiatric treatments.
What was the push for deinstitutionalization and was it uniquely positive?
After this there was a push to deinstitutionalize patients, get them out of hospital and into the community. There is good and bad about this. Many homeless now have mental disorders. Do we put a roof over their heads or are they better off in the streets; it is not clear where the balance is. Also many times patients released, commit suicide. Complicated issue.
WHat was the first thing that helped Clinical Psychology establish itself?
The first thing that helped Clinical Psychology establish itself was the Antipsychiatry movement (Psychiatry = bad guys psychologist = good guys)
What was the second source of support for clinical psychology?
The second source of support for clinical psychology was the beginnings in the 1950s of scientific support for psychological therapies.
Was there always support for Clinical Psychology?
Who reviewed the evidence?
It did not start well. In 1952, hand Eysenck reviewed the evidence for psyc treatments of non-psychotic patients. Found that 2/3 of patients improved over a 2-year period. But that there was no advantage over the wit list control groups. Great news for patients – most would naturally remit. Bad news for therapists. Eysenk was not pessimistic, he concluded that the therapies we had at this time is inefficient because we have not started testing them. If we are more attentive to what works/does not, we may create something better.
Whocame up with Behaioural Therapies?
What was it?
Is it still used?
In the 1960s Joseph Wolpe created behaviour therapy based on behavioural theories. Change observed behaviour rather than internal mental processes (e.g., systematic desensitization for phobias) – graded exposure to a feared stimulus). While the therapist does this, they teach the patient relaxation techniques. So you form new associations with the feared stimulus. Therapists still use this. You can also pair ammonia with something to repress the something by nauseating association.
Is behaviour therapy better than psychoanalysis?
Or waitlist?
In the 1970s Wolpe and Eysenk shows results that behavior therapy and psychoanalysis are equivalently goods, and both are better than a wait list condition. Across the studies, the most important thing is not the type of therapy but the relationship with the therapist (therapeutic alliance).
How did this evidence change the relationship between therapy and academic psychology?
So the scientific evidence helps promote clinical psychology. It also really helps with the relationship between clinical and academic psychology. Now the clinicians have scientific support for their therapy which makes this easier to accept for the academics.
When did Aaron Beck develop CBT?
Why did he disagree with Psychoanalysis?
Aaron Beck developed cognitive therapy in the 1960s and 1970s. He was a psychiatrist who was trained in psychoanalysis. He did research on depression. The prevailing Freudian theory at the time is that this is Thanatos instinct and anger, turned on oneself. He studied the dreams of the patient. He cannot find any signs of anger, just themes of loss and rejection.
What test for depression did Beck invent?
What did he think was behind depression?
Did he reach out to psychiatrists to discuss this?
This led to the development of the Beck Depression Inventory (BDI) which is still used. It also helped him come to believe that depression involves automatic, negative thought patterns – systematic biases in thinking (maladaptive cognitions). He started reaching out to psychologists (not psychiatrists, turning his back on psychanalysis).
Who did Beck reach out to and what had this person created?
One of the people he contacted was Albert Ellis creator of rational emotive therapy (RET).
What is Beck’s ABC model?
He proposed his ABC model – our reactions to a certain event are not so much a direct result of the event itself but rather, a result of our interpretation of that event.
- (A) Negative event – I got an A- in my exam: you could irrationally belief that you must always have As and so A- Is a failure. Or you could be rational: A- is a pretty good grate, have healthier emotions. Or blame the course/prof etc. What drives your response is how you interpret it. This is totally different from behaviouristic views which suppose that the event drives the response.
- (B) Rational Belief
- (C) Healthy negative emotion (not over the top)
What is Beck’s cognitive schema?
WHat is the Cognitive Triad?
What is a cognitive distortion?
In 1967 he publishes a book on cognitive theory of depression. At the centre is the concept of the cognitive schema – organises information on the cognitive triad: the self, the world and the future. He realized that depression was caused by beliefs about any of those 3 things. If you believe you are worthless, you wont accept a compliment etc. He called these processes cognitive distortions and theorised that they stopped people from leaving a depressed state and so underly depression.
What did Beck propose and what RCT did he use to test it?
As a result, he proposed cognitive therapy. Did the first RCT of therapy vs. antidepressants. Shows that it was as effective or a bit more. Up to this day, the combination of the two is recognised as being the most effective option.
What was the last thing that helped to devlop Cliical Psychology?
The last thing that helped Clinical psychology become a real discipline in the medical world. Before the 40s and 50s, therapy was the domain of doctors. They considered it a medical treatment and guarded access to it. Psychologists were not allowed to do it. Those that did, did it in clinics in universities, not in hospitals where they mostly administered tests.
In the 50s and 60s, drugs came on the market. These proved to be effective, it was a complete revolution ion psychiatry. They moved from psychotherapy, lobotomy and ECT to psychopharmacology.
Thus, they felt it was okay for psychologists to perform psychotherapy. The new role of the psychiatrist was to prescribe psychoactive drugs. The longer and more cumbersome job of therapy could be left to the psychologists.
What additional benifits did psychopharmatherapy have?
Pharmacotherapy had many beneficial impacts. Facilitated in house treatment of patients. You could release people from the hospital and send them home; better for them and the healthcare system. But it also had detrimental side effects.
People do not agree if this is good or bad, but it lowered the threshold for psychiatric treatment. We may also be over prescribing as the rates are huge.
Is psychopharmatherapy good or bad?
People do not agree if this is good or bad, but it lowered the threshold for psychiatric treatment. We may also be over prescribing as the rates are huge.
Who is Alex Berezow
We often and still see articles about why psychology is not a science. Alex Berezow is a very influential blogger and chemist. He started blogging about science, he is vocal and controversial. Does not like the idea of science because this weakens the definition of science in his view.
What is Operationalization?
Operationalization – take a concept, find a way to measure it. All science does this. Even distance must be operationalized – a ruler, trigonometry etc. It matters how you do this.
Why do psychologists spend so much time workig on research methods?
The birth of psychology is really an attempt to make itself a discipline, separate from philosophy. Make it a science. Even at the start, people resisted this (Kant, Comte etc) and so psychologists were under pressure to prove that psychology was a science. This is why research methods are considered so important (and why we have to learn them all the time. Psychologists tend to be good at statistics. This focus comes from the idea that it isn’t the topic you study but how you did it. Chemistry and alchemy – both interested in how different substances interact, but alchemy is not science and chemistry is, the difference is how they are studied. In fact, sometimes, a critique is that there are too many methodologists and not enough theorists. This may be a form of mechanolatry methdologism: the tendency to see methodological rigour as the only requirement for scientific research, at the expense of a theory formation.
What was the epistemology before the scientific method?
Before science:
Plato – senses are fallible, must use reason
Aristotle: deductive reasoning is the most solid but inductive reasoning is also valid, make inductions based on data
Aristotle: Correspondence theory of truth – truth is a property of a statement when it corresponds to reality. How much something conforms to external reality.
Scepticism: does not deny the existence of a physical reality, denies that we can have reliable knowledge of it.
Bacon’s contribution to the method
In the renaissance we have the scientific revolution. Stressed the importance of empirical data and inductive reasoning. Bacon recommended building tables of data and then use inductive reasoning to discover correlations of the data. He thought that if the data and tables were good enough, the truth would hit us in the face. Although he was well known for his ideas of science, he wasn’t a successful scientist himself, no great contributions.
What did Liebig say about Bacon’s work?
Did Galileo really use it?
Liebig: Although the accepted way was the one proposed by Bacon, in reality, no one worked that unimaginatively, Galileo: there was already data that suggested a heliocentric model, but there wasn’t enough to make it clear. With the addition of epicycles, the geocentric model was also working well. What he did was use deductive reasoning to make predictions that would be true if the heliocentric model was accurate. “if the heliocentric model is correct, then Venus should have phases like the moon, if the geocentric model is true, it wont” which he tested with a telescope. Venus had phases. Heliocentric was more likely to be correct.
Who came up with the hypothetico-deductive method?
This led philosophers of science like William Whewell to propose the Hypothetico-deductive method as the main driver of scientific discovery. It uses both inductive and deductive reasoning plus creativity to come to conclusions.
