Precursors and Origin of Clinical Psychology
A Profession Needs the Backing of a Reputable Organization
A Defining Role for Clinical Psychologists: Testing and Assessment
From Mental Asylums to Community Mental Health Centers
World War II: Clinical Psychology Gains Clout
This chapter presents an overview of the history of the professionalization of clinical psychology. Before progressing any further, we would like to acknowledge a much more in-depth and nuanced analysis that inspired much of what we say in this chapter, namely the full-length book by David B. Baker and Ludy T. Benjamin, From Séance to Science: A History of the Profession of Psychology in America (2014, 2nd ed.).
Here, we will first introduce the reader to the concept of “professionalism” and briefly review some the circumstances and motives that contributed to the development and growth of the professionalization of psychology, including the desire to demonstrate that psychology was a serious and useful science, as well as the contextual circumstances that facilitated its rapid development and public acceptance. We will then talk about psychologists’ effort to organize and seek recognition as a profession, followed by the most stablished practices in clinical psychology: Testing and Assessment, and Psychotherapy. We end with a description of an area of psychology that illustrates the potential reach of applied psychology for clinical and other psychologists, Forensic Psychology, as well as a brief description of the most common training model of doctoral clinical programs, and a bit of speculation about what may shape the future of applied clinical practices.
When you finish studying this chapter, you will be prepared to:
Well-known examples of professions include medical doctors, lawyers, and engineers. While there is not a universally accepted definition of what a “profession” is, it is generally understood that a profession is an occupation that requires specialized, scholarly-based knowledge or expertise learned through substantive and lengthy instruction (see What is a profession?, 2016). Included in the definition is also the expectation that independent practitioners will engage in continuous education and training to stay current with new advances and discoveries. This expectation is often made explicit within professional codes of conduct or ethical guidelines that urge practitioners to maintain high standards of competence and morally guided behavior. Without high expectations for performance and accountability, professions cannot preserve their reputation nor command the respect and trust of the public (Greenwood, 1957). For these reasons, professions normally rely on an official body or entity that sets minimum standards of education and training in order to ensure the profession serves effectively their clients and society at large (Greenwood, 1957).
The practice of psychology in the United States clearly meets the definition of a profession, as most states require a doctoral degree for independence licensure and practice in psychology. Psychologists are guided by the Ethical Principles of Psychologists and Code of Conduct (APA, 2002a) and are required to pass examinations and work under supervision before they become fully licensed and independent. In addition, state requirements dictate without exception that psychologists demonstrate engagement in continuous education to renew their licenses (Dittmann, n.d.).
Benjamin (2005) noted that a practice of “psychology” predated psychology, the scientific endeavor. For example, in the 18th and 19th centuries, before Wilhelm Wundt (1832–1920) or G. Stanley Hall (1846–1924) established the first psychology laboratories, there were many specialists who advertised psychology-like services. These services included tasks such as assessing individuals’ inclinations, or giving advice to help with behavioral and mental-health related problems (Sokal, 2001). We will not elaborate here on these “pseudo-psychologies,” although we invite the interested reader to review Chapters 3 and 6, where we provided an in-depth treatment of some of these early precursors of professional psychology (spiritualism is covered in Chapter 3, and phrenology, mesmerism, and hypnotism in Chapter 6).
Professional psychology eventually displaced 18th and 19th century pseudo-psychology occupations, and it is important to emphasize that professional psychology stemmed from the late 19th century birth of experimental psychology. The expanding presence of psychology in universities produced high numbers of doctoral psychology graduates who were ready and eager to apply their scientific knowledge of the mind to practical matters, particularly women psychologists who were systematically and prejudicially excluded from holding faculty appointments and practicing was often their only option to use psychology (Baker & Benjamin, 2014). Although the effort to apply scientific knowledge to professionalized endeavors was not universally accepted by psychologists, the professionalization of psychology was unavoidable. Sciences are valued and supported by society to the extent that their discoveries translate into practical applications, and for psychology that meant applying the new science of the mind to solve mind and behavior-related matters, such as raising and educating children, or treating individuals with mental health disorders.
We learned in Chapter 2 that the American Psychological Association (APA) was founded by Stanley Hall at Clark University in July 1892, and that the growth that made APA the largest organization of psychologists in the world was in great measure due to the professionalization of psychology. Prior to World War I (1914–1918), most psychologists were employed by universities teaching and conducting research, with some of them providing consulting services on the side to supplement their meager salaries. Nonetheless, there were also a few psychologists who worked full time in non-university settings such as juvenile courts, hospitals, or schools (Baker & Benjamin, 2014). As we will discuss later, during and after World War I, the interest in psychology and its applications grew, and psychologists realized they needed to differentiate themselves from the competing threats of pseudo-psychologists (e.g., phrenologists, mesmerists, etc.). Consequently, in 1917 a small group of psychologists led by J. E. Wallace Wallin (1876–1969) formed the American Association of Clinical Psychologists (AACP). Although the founders of AACP hoped that mere membership in the organization would serve as a certificate of professional legitimacy, they knew deep down their effort was insufficient. Other professions, such as physicians, protected their professional interests via state licensures that required evidence of formal training from accredited universities and medical schools. Thus, psychologists began to discuss the need to create a standardized professional curriculum, as well as a mechanism to accredit the institutions that would provide the instruction (Baker & Benjamin, 2014).
AACP founders were wise to organize to protect and advance their professional goals and interests. One the one hand, some of their own colleagues did not agree with the professionalization of psychology. On a second front, clinical psychologists had to battle physicians, who, out of concern of losing exclusive rights to treating the mentally ill, attempted to restrict psychologists’ expanding roles. For example, by 1917 two states had already allowed judges to use the expert testimony of clinical psychologists to institutionalize mental-health patients (Baker & Benjamin, 2014). That same year, the New York Psychiatrical Society published a report disapproving of psychologists interpreting psychological tests, diagnosing mental illnesses, and treating mentally ill patients (Franz, 1917).
The APA became concerned that the creation of the AACP would fragment and weaken their organization and thus invited the AACP to join them. In 1919, the members of AACP agreed to dissolve and joined the APA under the condition that they could have their own division, or “Section of Clinical Psychology,” within APA. Out of this union came the first attempt at creating a certification process to regulate the professionalization of psychology. Although in 1921 the Committee on the Certification of Consulting Psychologists was formed, the effort was abandoned in 1927, as only 25 psychologists had joined and paid the certification fee (Sokal, as cited in Benjamin & Baker, 2004, p. 54).
In the 1920s, professional psychologists also began to form local and state psychological associations to discuss matters of common interest. The largest of these organizations, the New York Association of Consulting Psychologists sought to extend its reach to the national level and created the Association of Consulting Psychologists (ACP). The ACP founded in 1937 its first professional journal, the Journal of Consulting Psychology, which in 1968 was renamed and is currently the Journal of Consulting and Clinical Psychology. Their agenda included mostly issues related to training, membership, licensure and certification, compensation and professional ethics. For example, in 1932 the ACP proposed standard undergraduate and graduate curricula that would be required of anyone aspiring to become a psychologist (see Farreras, 2014).
In 1937 the ACP and the members of the Section of Clinical Psychology of the APA joined forces to create the American Association of Applied Psychology (AAAP). The AAAP organized itself into four, independent, sections with their own separate bylaws: Clinical, Consulting, Educational, and Industrial psychology. Encouraged by the federal government due to the United States entrance in World War II, the APA and AAAP became a single organization in 1945. The APA agreed to adopt the divisional structure of the AAAP and to revise its bylaws to include the advance of professional psychology interests within its mission (Benjamin, 1997b).
World War II generated many needs that professional psychologists were ready to fulfill. For example, psychologists already had experience from World War I in the development and administration of intelligence tests to assess fitness to serve, as well as in the treatment of soldiers with “battle fatigue” or “shell shock” (or Post Traumatic Stress Disorder). The military relied on psychologists to help with recruitment, selection, training, equipment design, interviewing prisoners of war, etc. (Benjamin & Baker, 2004).
In anticipation of the high demand for mental-health services that World War II would create, the federal government authorized the Veterans Administration (VA) and the United Public Health Service (USPHS) on a plan to increase the number of trained clinical psychologists that could not only administer tests but also treat soldiers. The APA worked with the VA and USPHS to develop and identify high quality doctoral programs in clinical psychology, reviving the ACP’s agenda of 1932, which you may recall sought to establish standard curricula for anyone aspiring to become a psychologist. In 1947, David Shakow (1901–1981) chaired an APA committee that two years later produced a model of professional training that was called the “scientific-practitioner model” (a.k.a. the Boulder Model) (see Baker & Benjamin, 2014).
Another very important achievement for APA was the creation of an ethics code in 1953. The purpose of the code was to guide the conduct of professional psychologists and increased their accountability to their colleagues and the public. Over the years, psychologists distinguished between general principles and enforceable standards. The principles guided psychologists to arrive at ethical decisions across anything psychologists do. The standards are divided into defined expectations for the various roles such as research and publication, supervision, assessment, or therapy. There have been nine substantive revisions of the ethics code, with the most recent published in 2002, which was amended in 2010 and 2016.
As APA increased its membership, professional psychology dominated and the more science-oriented psychologists became dissatisfied. In 1998, nearly 100 years after the APA was founded, a new independent organization, the Association for Psychological Science (APS) was created. Today the APA’s membership has about 80,000 members (excluding student affiliates), and the APS has about 33,000 members—with an estimated membership overlap between the two societies of about 20% (APA Membership …, n.d.; Who we are, n.d.).
Clinical psychologists’ most distinguishing activity is that of testing and assessment, which includes intellectual ability, personality traits, and psychopathology. This tradition traces back to the anthropometric laboratories of Sir Francis Galton (1822–1911) in Europe, and James Cattell (1860–1944) in the United States (both discussed at length in Chapter 9). Cattell believed that his “mental tests,” a term he coined, would be useful to predict college students’ performance. Unfortunately for Cattell, his hypothesis failed when one of his students, Clark Wissler (1870–1947) used Galton’s newly invented correlation coefficient to demonstrate that Cattell’s mental test scores (reaction time, color acuity, etc.) did not correlate with college performance (Wissler, 1901b). Psychological testing was featured prominently in the psychology exhibits of the Chigago’s World Exposition of 1893, where Joseph Jastrow (1863–1944), a Polish-born professor at the University of Wisconsin-Madison, used a battery of anthropometric tests to assess visitors (see Baker & Benjamin, 2014).
Lightner Witmer (1867–1956), taught psychology at the University of Pennsylvania where he investigated individual differences in sensory perception. Some of his students were school teachers, one of whom asked Witmer for help with a 14-year-old boy who had difficulties spelling. Witmer assessed the student and offered helpful advice. Soon, the requests for help increased and the first psychology clinic was born. Witmer also began a new journal entitled The Psychological Clinic, and perhaps his greater contribution was to put in practice a systematic and sound method of treatment planning that is based on team work (including teachers and other professionals) and rigorous standardized testing.
Henry Herbert Goddard (1866–1957), also a professor at the University of Pennsylvania, became the Director of Psychological Research for the New Jersey School for the Feebleminded Boys and Girls, in Vinland, NJ. In a trip to Europe, Goddard learned about Alfred Binet (1857–1911) and his test to measure children’s mental age. Unlike Cattell’s sensory perception and motor abilities tests, the Binet scale assessed abilities needed to do well in school (e.g., verbal and numeric fluency, comprehension, etc.) and the scale scores were correlated with school performance. In 1908, Goddard translated, adapted and used the Binet test at the Vinland School.
Lewis Terman (1877–1956) of Stanford University also adapted a version of the Binet scale in 1916, the Stanford–Binet (SB), to improve the measure’s ability to assess intellectual ability in children and adults of above average intelligence. Goddard, Terman and others met at Vineland, New Jersey, in 1917 to develop an intelligence test that could be efficiently administered and scored to screen out recruits for World War I. The group developed two tests, one for those who were fluent in English and could read and write, the Army Alpha, and one for those who could not write and understand English, the Army Beta. Whereas the tests turned out to measure intelligence poorly, the measures were administered to almost two million individuals and the effort brought positive publicity and improved the reputation of psychology in the public eye (Benjamin & Baker, 2004).
It is important to note that over the years, different intelligence test batteries have been developed or updated. The SB, which dominated the market for intelligence test for over four decades, has gone through many iterations, with the most current one, the SB, 5th edition, published in 2003. One of the most widely adopted scales, the Wechsler–Bellevue Intelligence Scale (WBIS), was developed by Romanian-born, but American, psychologist David Wechsler (1896–1981). Instead of using the concept of “mental age,” Wechsler defined normal or average intelligence as the average standardize value of 100. One of the advantages of the new method was that psychologists could compare an individual’s performance over time and determine whether intelligence scores improved or deteriorated over time (see Boake, 2002).
The WBIS was originally designed to measure intelligence in adults; a children’s version (the WISC) was published in 1942; and a second adult version (the WAIS) became available in 1955. New versions of the WISC and WAIS have been published, along with other new intelligence tests. Three main factors have contributed to the proliferation of new scales and updates. On the one hand, new scales or iterations of old instruments aim to fix weaknesses or shortcomings pointed out by new research and theories. Second, new versions of all instruments render content and testing materials contemporary. A third factor is profit. Intelligence tests are in high demand because they play a very important and necessary role across a broad spectrum of circumstances (e.g., assessing learning disabilities, competence to stand trial, etc.).
Based on Carl Jung’s (1875–1961) word association psychoanalytic technique, which he introduced to America in journal articles and conference talks between 1907 and 1910, psychologist Grace Kent (1875–1973) developed a 100-word association test that she administered to 1,000 normal individuals and 247 psychiatric hospital patients. Kent used the data to create frequency tables she could then use to determine the extent to which the associations produced by anyone individual were typical or atypical. The scale was called the Kent–Rosanoff Association test (Trespalacios, 1982).
Robert Woodworth (1869–1962), a professor at Columbia University, constructed in 1919 the first paper and pencil, clinical personality test, the Personnel Data Sheet. The test consisted of 116, yes–no items that likely measured “neuroticism.” The test was commissioned by the army with the purpose of identifying soldiers susceptible to shell shock, and was administered at the Plattsburg Army Hospital by Harry levi Hollingworth (1880–1956) (Benjamin & Baker, 2004).
A Swiss psychiatrist, Hermann Rorschach (1884–1922) created one of the most, if not the most, famous projective personality tests, the Rorschach (inkblot cards). Projective tests are based on the psychoanalytic belief that individuals’ behaviors and personality are governed by unconscious thoughts and motives. To get to the unconscious, projective tests present ambiguous stimuli that provoke more honest, less defensive responses in the person reacting to the stimuli. Psychiatrist David Levy (1892–1977) introduced the Rorschach in America in 1921. The Rorschach became more popular in the 1940s after psychologists Samuel Beck (1896–1980) and Bruno Klopfer (1900–1971) developed a standardized method to scoring and interpret subject responses (Benjamin & Baker, 2004).
Christiana Morgan (1897–1967) and the director of Harvard’s Psychology Clinic, Henry Murray (1893–1988) created the Thematic Apperception Test (TAT) in 1935. The TAT is also a projective test consisting of ambiguous pictures. Similar to the Rorschach, subjects are presented one card at a time and then asked questions about the picture. In the TAT’s case, the person is asked to say what happened before the picture, what is happening in the picture, and what will happen in the future. Although the Rorschach and TAT dominated clinical psychology practice in the 1940s, gaining proficiency in projective test administration and scoring is no longer required by most clinical graduate programs (see Aronow, Weiss, & Reznikoff, 2013).
University of Minnesota psychologists Starke Hathaway (1903–1984) and psychiatrist J. Charnley McKinley (1891–1950) published the Minnesota Multiphasic Personality Inventory (MMPI) in 1943, a paper and pencil test that promoted objective personality tests in the 1940s. The MMPI consisted in 561, true–false self-statements, and the test was standardized on normal individuals and mental health patients with one of nine mental diagnoses. This approach allowed for the construction of individual scales that characterized the response patterns of specific patient groups, as well as what score combinations across scales, or profiles, were most common for each patient group. The MMPI became a powerful tool to help with the diagnosis of specific psychopathologies, used for multiple applied purposes, such as personnel selection, or parent custody trials. In 1989, the MMPI was revised and updated with a much larger, more representative sample to create the MMPI-2. Further refinements and updates include the creation of a version for adolescents, MMPI-A (1992), and a relatively shorter, more precise and restructured form, the MMPI-2-RF (see Ben-Porath & Tellegen, 2008). Other personality and diagnostic inventories include Theodore Millon’s (1921–2014) Millon Clinical Multiaxial Inventory (1977), and Paul Costa and Robert McCrae’s, NEO-Personality Inventory (1985).
The treatment of mental disorders had been the domain of medicine and psychiatry for over 100 years before the arrival of scientific psychology. The history of clinical psychology is in part the history of how psychologists slowly but surely began to take responsibility for many of the roles that had been the exclusive domain of psychiatry, a journey that continues to present days and is not better demonstrated than with psychologists’ quest to obtain prescription privileges (see Chapter 2). What follows is a brief overview of the stepping stones that helped clinical psychologists increase their presence and role in the planning and treatment of individuals with mental disorders. Although the relationship between psychologists and physicians was not always harmonious, you will notice that much of the territory gained by clinical psychology was aided by allies from medicine. We start with a brief history of the mental asylums in America, which provide important background to understand the evolution and challenges of caring for the mentally ill.
The mental asylum movement in America was largely inspired by the work of Philippe Pinel (1745–1826), a French psychiatrist and superintendent of asylums for the mentally ill in Paris. Pinel became world renowned for believing that insanity could be cured through humanization of the cruel and punishing treatments of his time. In the United States, the first few mental asylums opened in the second half of the 18th century. However, with the industrial revolution and the rapid growth of cities, the need for asylums increased exponentially and their construction exploded. The first asylums were built to house no more than 250 patients, which allowed for the provision of individualized “moral treatments.” Moral treatment consisted of a combination of interventions that included activities such as occupational therapy, exercise and recreation activities, self-care training, and aesthetic activities (e.g., gardening, painting, music, etc.). In addition to these behavioral–psychological treatments, the physicians who were in charge at the asylums also treated patients with physiological therapies (e.g., bloodletting, cold baths) and medications (e.g., insulin, opium) (see Baker & Benjamin, 2014).
Unfortunately, the demand for asylum beds grew disproportionally fast and asylums became overcrowded, poorly funded, and understaffed, massive warehouses for the mentally ill. Under these deteriorating conditions, moral therapy was simply not possible. In response to public dissatisfaction, John F. Kennedy signed in 1963 the Community Mental Health Centers Act, which would move the care of hundreds of thousands from about 300 state hospitals to smaller, closer to home, mostly outpatient Community Mental Health Centers (Baker & Benjamin, 2014).
At the turn of the 20th century, several events would influence the work of clinical psychologists. We have noted that Witmer’s psychology clinic was founded in 1896, but it was not until the 1910s that similarly run clinics became research, training, and treatment centers at a number of other universities. A second important development for the psychology clinic was the incorporation of research, diagnosis, and treatment in juvenile facilities. A pioneer of this effort was William Healy (1869–1963), a physician who directed the Juvenile Psychopathic Institute in Chicago. Healy was influenced by Goddard and James and worked side by side with clinical psychologists, including his wife, Augusta Bronner (1881–1966) (Benjamin, 2005).
Morton Prince (1854–1929) was another physician who valued and sought the input of psychologists. Prince was an American neurologist interested in the study and treatment of psychopathology. In 1906, he founded the Journal of Abnormal Psychology (JAP), which became an important outlet for psychologists to present their input on matters related etiology of mental disorders. Prince donated the journal to the APA, where JAP is still today, and is one of the most highly regarded journals of psychology (Baker & Benjamin, 2014).
Elwood Worcester (1862–1940), a psychologist who studied with Wundt, believed that physical ailments were rooted in psychological and spiritual causes. This led him to conclude that religion could become and effective healing vehicle. In 1904, he became the rector of the Emmanuel Church in Boston, where he began to treat his parishioners using a mixture of relaxation and suggestive hypnosis. Neither psychiatrists nor psychologist were welcoming of Worcester’s approach, with psychiatrics worrying about psychologists intruding in their professional turf, and psychologists considering that spirituality and religion were outside the scientific domain (Benjamin, 2005).
Adolf Meyer (1866–1950), a psychiatrist, partnered with Clifford W. Beers (1876–1943), a mental health patient who had been institutionalized for almost two years. Beers and Meyer published a book entitled A Mind that Found Itself. The book narrated the cruelties that Beers had witnessed or experienced while being institutionalized. In 1909, Meyer and Beers found the Mental Health Movement to protect the interests of mental-health patients and promote science-based mental health research and practices.
However, among these early 20th century events, none probably had as much influence as Sigmund Freud’s (1856–1939) and Carl Jung’s visit to the United States in 1909. Their visit made psychoanalysis widely popular and accepted by psychiatrists. Although psychologists generally regarded psychoanalysis outside of the scientific domain, clinical psychologies were among the more receptive, and many would receive training to become psychoanalysts.
Also in the 1920s, a national reform movement was initiated to cope with an emerging juvenile delinquency problem. From 1921 to 1927, more than 100 child guidance clinics were created with the purpose of preventing delinquency. Their approach was to improve early detection of intellectual problems and conduct disorders in youth and provide appropriate instruction and support to the children and their families. These clinics were typically staffed by a psychiatrist, clinical psychologist, and several psychiatric social workers (Benjamin, 2005).
The door to treatment and psychotherapy became wide open when the military called on psychologist’s services to help with World War II. More than 400 clinical psychologists contributed their services, and most of them, in addition to taking an important role in testing and assessing military personnel, provided psychotherapy. After the war, psychologists continued to gain ground and made for themselves a legitimate place in the treatment planning and the provision of psychotherapy. In 1946, Virginia was the first state to license psychologists, which was highly meaningful because a licensure defines and restricts the practices to a profession. Eventually, all 50 states passed psychology licensure laws, with the last one happening in 1977. In addition to licensing laws, psychologists also sought to create something similar to the board-certified accreditations awarded in medicine. In 1947, the American Board of Examiners of Professional Psychology (ABEPP) was formed to give certified diplomas of competence. This organization is today known as the American Board of Professional Psychology (ABPP) and provides diplomas in 15 different professional subspecialties (About ABPP, n.d.) (see Benjamin & Baker, 2004).
In the 1960s, practicing clinical psychologists found work opportunities in Community Mental Health Centers, Veteran’s Administration and other hospitals, and the judicial system. In addition, as licensure privileges became normative across the states, the number of psychologists who worked in independent clinical practice increased. By the 1970s, the stereotypical psychologist was a clinical psychologist offering psychotherapy in private practice, a prototype that progressively became a reality as their services could be offered without psychiatric referral or supervision and still be reimbursed by health insurance companies (DeLeon, VandenBos, & Bulatao, 1991).
Managed Care in the 1980s brought considerable change to both the economic status and the practice of independent clinical psychology. Managed Care is an organized health care system designed to contain the cost of health care delivery. These systems began in the 1950s as a way to deliver uniform and preventative care to employees, which in turn could improve the health of the employees and reduce the need for more expensive medical procedures. In managed care, organizations called HMOs contract out specific medical-service packages to employees of large companies for a combined prepaid (insurance) price and a fixed (reduced) price per service delivered. The packages define the services provided by the HMO. From the 1960s to the 1970s, the number of HMOs and the coverage of the mental-health services they offered grew considerably, particularly after 1973, when the Health Maintenance Organization Act was passed to federally support the creation of new HMOs. Initially, the Act required HMOs that received any federal funding to provide a minimum of 20 psychotherapy sessions per year. This provision could in theory have reduced the overall cost of health care delivery, for research has shown that outpatient psychotherapy can reduce mental-health costs by avoiding very expensive mental-health related hospitalizations (DeLeon et al., 1991).
However, to contain health care costs, HMOs and health insurance companies would progressively increase their reliance on strict strategies that limit the beneficiaries’ flexibility in choosing their providers and what services they can seek. In the case of out-patient mental-health delivery, HMOs have limited considerably the number of sessions offered within their plans (often limited to 5–8 sessions), the number and types of assessments allowed, and the fees paid to psychologists. It is safe to say that Managed Care has substantively lowered the annual income of most clinical psychologists in private practice. It is not surprising that clinical psychologists often express concern and frustration over the highly bureaucratic nature of HMOs, their intrusiveness, and their resistance to extend psychotherapy or assessment services. These concerns are also ethical in nature for two main reasons. Seeking approval to provide or extend treatment unavoidably erodes patient–client confidentiality. Imposing treatment restrictions invariably weighs cost containment against quality of treatment.
Except for those psychotherapists who work outside Managed Care and have clients willing and able to pay their fees, Managed Care has in great measure ended psychotherapists’ golden years. Not only has Managed Care reduced psychologists service fees, limited their services, and increased their paperwork and administrative costs, but today other occupations are encroaching on clinical psychologist’s territory (e.g., social workers, master level psychologists). If current trends continue, it is unlikely that providing psychotherapy in independent practice will be the vehicle by which practicing clinical psychologists will seek to maintain high professional clout and status.
Although we normally associate the word “forensic” with scientific techniques applied to understand whether, who, or how a crime was committed, “forensic” before psychology takes on a broader meaning. Forensic psychology encompasses the work of psychologists working in all areas of the judicial system, such as police departments, courts, and prisons. Thus, forensic work for a psychologist ranges from providing testimony in court on a child custody case to providing a psychological profile of the perpetrator of a crime or series of crimes.
Baker and Benjamin (2014) pin the birth of forensic psychology to 1906 by the hand of Hugo Münsterberg (1863–1916). A defense lawyer sought Münsterberg’s help with a man who declared himself guilty of murder but later recanted his confession. Münsterberg concluded the man was innocent but his expert opinion was ignored and the man executed. This and other cases motivated Münsterberg to write, On the Witness Stand (1908). Münsterberg believed that psychological science could provide important insights in evaluating evidence, identifying false confessions and testimonies, and assessing the accuracy of eyewitnesses. Münsterberg is credited with making the first attempts to detect lying via systematic and scientifically tested methods. For example, he believed that in a word association task, individuals would take longer to respond when the word carried an emotionally charged meaning for them. Eventually he moved beyond reaction time to add physiological measures, including the Galvanic Skin Response (GSR), methods that were precursors to the modern, lie-detecting polygraph (Benjamin & Baker, 2004).
Assessment is a central task of forensic psychologists because their expert testimony is often sought to establish court matters such as competency to stand trial, risk to self or others, insanity allegations, or child custody in divorce or child-protective services proceedings. Psychological evaluations are often routine in the judicial system for probation or parole decisions. These evaluations may involve a comprehensive examination of the individual’s history, an interview, and a battery of intellectual functioning and personality tests. Whereas assessment of functioning or fitness, as well as prediction of future behavior, are often the questions sought in the judicial system, assessment referrals may also include request for psychological and behavioral treatment recommendations.
Psychologists help lawyers with jury selection or assess how mock juries may react to different defense arguments, determine the psychological impact that negligence and discrimination may have had in their clients, or predict the impact of sentencing decisions on third parties (e.g., impact of deportation on the American children of an illegal immigrant). Forensic psychologists may also work with lawyers seeking advice in assessing the truthfulness of testimony, or may theorize about the likelihood that a particular individual engaged in a given behavior.
Forensic psychologists do work as behavioral profiles for the FBI, Secret Service, and police departments, although their opinions are most likely more tentative and not as quick as the conjectures assured in serial-killer television shows and movies. For example, their job may consist in assessing the risk of an individual carrying out a particular threat. An intriguing service is the Psychological Autopsy, which consists in ruling out or confirming whether an individual’s death was caused by a suicide. The autopsy consists of interviewing people familiar with the individual’s history and state of mind, as well as any records relevant to the person’s mental and physical health (Isometsä, 2001).
The typical path to becoming a clinical psychologist starts with a bachelor’s degree in psychology, followed by a PhD (Doctor of Philosophy) or PsyD (Doctor of Psychology), initiating a lengthy licensure application process, one year of post-doctoral supervised practice, passing the EPPP (a 225-question multiple-choice test on core areas of psychology), and passing state-specific written and oral examinations.
The bachelor’s degree in psychology is typically understood as a foundation that facilitates the students’ progress through the more in-depth and demanding work expected of graduate courses. Clinical graduate programs generally require a similar series of courses to those required for the bachelor’s degree (i.e., research methods and statistics, and the biological, social, developmental and leaning-cognitive basis of behavior), plus a number of specialized courses on intelligence testing, personality assessment, test construction and psychotherapy theories and techniques. For example, the incorporation of social media technology and practices, as well as smartphone applications and other software already play a role in testing and treatment delivery, and they will undoubtedly continue to play an increasingly important role in the future.
We want to end with a perhaps provocative proposal. As Managed Care continues to limit the length of services, augment accountability, and reduce the fees they pay for services, the training and educational attainment of those willing to treat people with mental health problems will not be at the doctoral level. In addition, if Managed Care were to invest in prevention by means of by way of incentivizing healthy habits and avoidance of high-risk behaviors, we could see an upsurge of interventions aimed to promote good habits, such as eating well, drinking in moderation, avoiding drugs, exercising, etc. Whereas the design and outcome assessment of these programs will likely require the training and expertise of doctoral level psychologists, the actual delivery of these programs could probably be carried out by master, or even appropriately trained, bachelor psychology graduates. These jobs would require acting in roles such as instructors, coaches, or simply monitors of compliance, progress, and/or obstacles to success. If psychologists do not take to the task of training individuals at the bachelor level to take a role in the delivery of helping services that require psychological expertise, what will stop other disciplines from entering this niche?
A profession is an occupation that requires specialized, scholarly-based knowledge or expertise learned through substantive and lengthy instruction. Without high expectations for performance and accountability, professions cannot command the respect and trust of the public.
For this reason, professions rely on organizations that set minimum standards of education and training. For practicing clinical psychologists, the most influential organization that sets standards and lobbies for the rights and privileges of clinical psychologists is the American Psychological Association.
We note that the future of clinical psychology may lay in the incorporation of innovative approaches to training and research, such as the already existing joint psychology and law programs that offer a doctorate in psychology and a law degree (JD). The future of clinical psychology might be forged by those psychologists who embrace the new challenges of our time and have the imagination and courage to open new paths of inquiry and application. Also, as Managed Care continues to evolve and prevention interventions become normative, we see an occupational role for bachelor psychology graduates, who could ably serve as instructors, coaches, and cheerleaders for specific, health-promoting training programs.