Clinical Psychology in North America, History of

Donald K Routh, University of Miami, Coral Gables, FL, USA

2001 Elsevier Ltd. All rights reserved.
This article is reproduced from the previous edition, volume 3, pp. 20292036, 2001, Elsevier Ltd.

Abstract

The rst psychology clinic in the world was founded by Lightner Witmer at the University of Pennsylvania in 1896. Clinical
psychologists in the United States rst organized themselves in 1917. This eld was greatly expanded after World War II with
funds from the US government for training. In Canada and Mexico, clinical psychology developed mostly after World War II.
Thus, a 1965 conference in Canada endorsed the doctoral training model previously developed at a 1949 conference in the
US. In French-speaking Canada, masters level training was more typical, whereas in Mexico a 6-year licentiate degree pre-
vailed. Today, in North America as elsewhere in the world, clinical psychology is concerned with the study of psychopa-
thology and with its diagnosis and treatment.

Clinical psychology is concerned primarily with the study of
psychopathology and with its diagnosis and treatment. It shares
this domain with several other mental health disciplines,
including psychiatry, social work, nursing, and various types of
counseling. Compared to these other disciplines, clinical
psychology is distinctive for its training in research and for its
expertise in psychometrics and the behavior therapies. North
America played an important role in the emergence of clinical
psychology. The eld usually dates its origin from the founding
of the rst psychology clinic in 1896 by Lightner Witmer (1867
1956) at the University of Pennsylvania (Routh, 1996). Clinical
psychology in the English-speaking parts of Canada developed
in a pattern similar to that seen in the US (with doctoral training
required for independent practice) but somewhat later in time.
The eld developed in French-speaking Canada and in Mexico
in a way more resembling that of European countries, with
masters or licenciate-level training required for independent
practice. The North American Free Trade Agreement now exerts
pressure on all three countries and their states and provinces to
coordinate these differences to a greater degree, to permit more
freedom of movement to qualied clinical psychologists.
The Prehistory of the Mental Health Field
The need for humans to deal with the problems now called
mental illness did not emerge suddenly a century ago. It seems
reasonable to assume that such problems have existed in some
form in every society through all the millenia of human
experience. The ancient literature of India, Egypt, China,
Greece, and Rome contain descriptions of disturbed behavior,
often interpreted in religious terms as some type of retribution
by magical or divine forces. Legal systems as they developed in
all of these civilizations necessarily included provisions for
seeing to the management of the affairs and property of
persons who were temporarily or permanently unable to
manage for themselves (Routh, 1998).
physician Hippocrates (460377 BC). These Hippocratic writings
include terms such as melancholia, mania, paranoia, and
dementia, with meanings not all that different from their present
ones, albeit with different explanations. For example, in Greek,
the word melancholia simply means black bile. In the Hippo-
cratic theory of the humors, a person suffering from severe mental
depression had an overabundance of black bile, a substance
thought to be produced by the spleen. Within this system, one
aspect of treatment quite reasonably aimed to reduce the amount
of black bile by administering a purgative such as hellebore.
Another disorder was that of phrenitis, literally meaning an
inammation of the mind. This referred to mental disturbance
accompanied by fever, and the approach taken was simply to wait
for the fever to abate. Though some of these Hippocratic ideas
may seem strange to us now, it is worth reecting why some of
them lasted well into the eighteenth century and beyond.
Emergence of Psychiatry
Although according to Herodotus (c.484425 BC), medical
specialties existed even in ancient Greece, the one we now call
psychiatry did not emerge until the late eighteenth century in
Europe. The ancients did not conceptualize mental disorders as
a separate category but regarded them as being illnesses like any
other. When psychiatry did emerge, with the work of such
pioneers as Philippe Pinel (17451826), Benjamin Rush
(17451823), and Vincenzo Chiarugi (17591820), it was
associated with the development of mental asylums or hospi-
tals as a separate locations for the care of those with mental
derangements. The theory of moral treatment that was typical
of that time tried to minimize the use of coercive methods such
as chaining patients to restrain them and instead insisted that
they be treated with kindness and courtesy. It was often found
that even some very disturbed patients responded positively to
such a regimen.

Modern Psychology and the Study

Greek Ideas Concerning Psychopathology of Psychopathology

Western concepts of psychopathology have their roots in those of Long before a formal discipline of psychology existed, people
the ancient Greeks, including the writings attributed to the in every society still no doubt reected upon human experience

International Encyclopedia of the Social & Behavioral Sciences, 2nd edition, Volume 3 http://dx.doi.org/10.1016/B978-0-08-097086-8.03027-0 877
878 Clinical Psychology in North America, History of
and behavior. As was the case of Hippocrates in relation to
medicine and psychiatry, the inuence of ancient Greek
philosophers such as Plato (427347 BC) and Aristotle (384
322 BC) upon our present psychological concepts was perva-
sive. There is conventional agreement that psychology emerged
as a formal academic discipline only in the mid-nineteenth
century in Europe. Wilhelm Wundt (18321920) of the
University of Leipzig is usually named as the founder of the
eld, and 1879, the year in which he set up his psychology
laboratory there, is celebrated as the key event in its origin.
Wundts work and those of the other early psychologists often
focused on sensory processes, reaction time, and memory. It is
also noteworthy that the study of psychopathology was
a possible topic of psychological study even in those days. The
eminent psychiatrist Emil Kraepelin (18561926) was inu-
enced by Wundts writings and was interested in psychology.
His main motive for becoming a psychiatrist was that this was
the only way he could see to make a living while doing
psychological research. He later actually studied under Wundt,
who encouraged him to keep on with his work combining
psychology and psychiatry. Kraepelin set up psychology labo-
ratories at his psychiatric clinics in both Heidelberg and
Munich.
Many of the pioneers in psychology in both Europe and the
US were trained as medical doctors. In France these included
Theodule Ribot (18391916), who wrote about diseases of
memory and about personality disorders. An important French
colleague was Pierre Janet (18591947), who studied anxiety,
hysteria, and obsessions and developed concepts of dissocia-
tion that continue to be inuential today. In the US the leading
pioneer in psychology, William James (18421910) was orig-
inally trained in medicine but wrote a psychology textbook that
proved to be the most inuential of all. In 1896, James gave his
Lowell lectures on exceptional mental states, much inuenced
by the work of Janet. Boston neurologist Morton Prince also
became interested in Janets writings and published a descrip-
tion of a woman with multiple personalities who had been his
patient. Prince established the Journal of Abnormal Psychology in
1906 and later gave it to the American Psychological Associa-
tion. Subsequently, in 1926, he established the Harvard
Psychological Clinic, which was a research facility rather than
one delivering mental health services. The most inuential
medically trained student of psychology of this time was no
doubt Sigmund Freud (18561939). Breuer and Freuds book
Studies in Hysteria, was published in 1895 and Freuds book on
the interpretation of dreams in 1900. The rst international
psychoanalytic meeting was held in Salzburg in 1908. In 1909,
Freud came to the US for the rst and only time.
Lightner Witmer and Clinical Psychology
As the above paragraphs make clear, Witmer was hardly the rst
to suggest that psychologists study psychopathology. Instead,
his main contribution was to go beyond that to advocate that
psychologists try to help people as well as study them. Witmer
had been an undergraduate at the University of Pennsylvania
and then for a time, before going to Leipzig to obtain his PhD
under Wundt, served as a school teacher. He had as a student
a young man with marked difculty in reading and was able to
help the youngster succeed in school and go on to attend
college. This turned out to be a formative experience for
Witmer. After Witmer had obtained his PhD and returned to
his alma mater as a psychology professor, a school teacher
named Margaret Maguire asked his advice about one of her
pupils with a spelling problem. Witmer reasoned that if
psychology was of any practical use, it should be able to be of
help in a case of this kind. Thus was the psychological clinic
and the eld of clinical psychology launched.
Witmers clinic worked more with children than with adults
and tended to concentrate on academic difculties such as
reading, spelling, or general backwardness in school as
opposed to emotional or behavioral problems. His historic
forebears are thus not Hippocrates and Pinel but rather eigh-
teenth and nineteenth century French physicians and special
educators such as Jacob Pereire (171580) (who taught deaf-
mutes to speak), J.M.G. Itard (17751838) (who worked
with the wild boy of Aveyron), and Edouard Seguin (1812
80) (a physician who devised a physiological method of
sensory and motor training in an attempt to remediate mental
retardation). Witmer used existing laboratory procedures
including the Seguin formboard and sensory/motor procedures
adapted from Wundt to evaluate the children referred to him
and often tried to teach them simple tasks as a part of his
diagnostic efforts. In his treatment activities he often collabo-
rated with school teachers, as well as with physicians, thus
serving as more of a consultant than doing anything resem-
bling present-day psychotherapy. As a matter of fact, he was
little inuenced by the activities of the Boston School of
psychotherapy that was contemporary with his work, nor later
by Freud and his psychoanalytic movement.
Witmer is not remembered for any noteworthy scientic
discoveries but rather for his persistence in enacting this new
role of the clinical psychologist. At the University of Pennsyl-
vanias PhD program, he essentially trained most of the rst
generation of clinical psychologists. He maintained his clinic as
a service and training facility and in 1907 began a journal, the
Psychological Clinic, to publicize these activities (Witmer, 1907).
The Binet Test
There is still no consensus among psychologists as to precisely
how to interpret its ndings. Still, Alfred Binets metric scale of
intelligence (Binet and Simon, 1905) may be the most note-
worthy piece of technology developed by psychology in its rst
century. Certainly it had a major impact on the new eld of
clinical psychology. In fact, before World War II, probably the
most characteristic activity of the typical clinical psychologist
was the administration of the Binet test and other similar
measures (Routh, 1994). This was true despite the fact that
Lightner Witmer, the founder of the eld, was quite critical of
the Binet test and used it only as one part of his extensive
battery of laboratory procedures.
In the light of how inuential his test was, it is interesting to
note that Alfred Binet himself was not particularly identied
with the eld of clinical psychology. Originally trained as
a lawyer, Binet became part of the circle around the inuential
neurologist Jean Charcot at the Salpetriere in Paris. Much of his
psychology was self-taught, through extensive reading at the

Bibliothque Nationale. In France, Binet became known as one of
the founders of the entire eld of psychology (often charac-
terized worldwide as experimental psychology) and edited the
inuential journal, Annee psychologique. As is well-known,
Binets successful attempts to devise an intelligence test
departed from the conventional approach of using relatively
pure sensory and motor tasks to use complex worksamples of
the kinds of things school children might be expected to know
and do.
For some reason, Binets new test did not create as much of
a stir in his homeland as it did in the US. Psychologist Henry
Goddard, who directed the psychology laboratory at the
Vineland Training School, in New Jersey, had the Binet test
translated and soon conrmed its impressive validity in iden-
tifying persons with mental retardation. The use of the Binet
spread like wildre among the early clinical psychologists in
the US, beginning with those employed in the eld of mental
retardation. Goddard founded the rst psychology internship
in 1908 at Vineland, NJ. Goddard went on to become the rst
professor of clinical psychology at Ohio State University, like
the University of Pennsylvania an important early training
center in the eld (Routh, 1994).
Lewis M. Terman (18771956) at Stanford University
developed a standardized version of Binets test, collected
normative data for it, and introduced certain renements
such as the ratio IQ score (originally suggested by Wilhelm
Stern of Hamburg). The 1916 Stanford-Binet, as it was
called, dominated this eld for many years. At about the
same time, 1915, Robert Yerkes pointed out the unsuit-
ability of the concept of mental age and of this testing
format for use with adults and introduced his own point
scale as a substitute for it. Yerkes and his colleagues were
also responsible for the development of group intelligence
tests, the Army Alpha (for those who could read) and Army
Beta (for the illiterate), used for mass testing of military
recruits during World War I. Another wartime development
was Robert S. Woodworths Personal Data Sheet published
in 1917. This was one of the rst rationally developed self-
report questionnaires intended to detect neurotic tendencies
(Routh, 1994).
The Child Guidance Center Movement
The development of child guidance centers was another factor
that inuenced early clinical psychologists in the direction of
working with children more than with adults. The rst child
guidance clinic was the Institute of Juvenile Research, estab-
lished in 1909 by physician William Healy in conjunction
with the juvenile court of Chicago. The idea behind such
facilities was that careful clinical study of children engaging in
antisocial activities could assist in guiding them away from
crime. Healy was joined at rst by clinical psychologist Grace
Fernald and subsequently by her replacement, Augusta Bron-
ner (Healy and Bronner, 1926). The child guidance clinic was
the origin of the clinical team of psychiatrist, psychologist,
and social worker that later spread to other settings. The typical
pattern was that the psychiatrist saw the child, the social
worker saw the family, and the psychologist did the testing.
The child guidance movement was supported by the Harkness
Clinical Psychology in North America, History of 879
familys philanthropy in the form of the Commonwealth Fund
and replicated in many US cities and abroad.
The First Clinical Psychology Organization
In 1917, in Pittsburgh, a group of eight clinical psychologists
organized themselves into what they called the American
Association of Clinical Psychologists and invited 48 colleagues
to join them (Routh, 1994). They were led by J.E.W. Wallin
(18761969) and Leta Hollingworth (18861939). Inciden-
tally, Hollingworth was the rst to suggest in 1918 that
a person trained in clinical psychology receive a distinctive type
of degree, the doctor of psychology. The new organization was
viewed by many as divisive and was soon incorporated into the
American Psychological Association as its Clinical section. An
effort by the same group to introduce procedures for certifying
qualied clinical psychologists failed, however.
Psychometric Developments
The interwar years were a fertile time for the emergence of
various new psychometric procedures, many of which continue
to be in use today. For example, in 1921, the Swiss psychiatrist
Herman Rorschach (18841922) published his well-known
inkblot test. It was brought to the US by a child psychiatrist
who taught it to a clinical psychology graduate student at
Columbia named Samuel Beck (18961976). Beck then pro-
ceeded to do his dissertation on this new test and eventually to
develop his own system for administering and scoring it.
Psychologist Bruno Klopfer (190071), a disciple of Carl Jung
(18751961), also introduced the Rorschach to the US and
developed a separate system for administering and scoring it
(see Projective Methods in Psychology). In 1936 the Thematic
Apperception Test was introduced by Henry A. Murray (1893
1988) of the Harvard Psychological Clinic, and a colleague.
Also in 1935 Edgar A. Doll (18891969), introduced the
Vineland Social Maturity Scale, an interview-based method
involving informants familiar with the person, for assessing the
social competence of individuals suspected of mental retarda-
tion. David Wechsler (18961981) published the original
version of his Wechsler-Bellevue intelligence test for adults.
This was but the rst of many Wechsler tests of intelligence and
memory. It introduced the use of the deviation IQ, a standard
score comparing the individual to age-matched normative
subjects. In 1943, psychologist Starke R. Hathaway and
psychiatrist J.C. McKinley introduced the rst edition of the
Minnesota Multiphasic Personality Inventory (MMPI). The
MMPI had novel validity indicators, and its measures of
psychopathology were empirically keyed to psychiatrically
dened groups (see Minnesota Multiphasic Personality
Inventory).
Organizational Activities
In 1937 a new organization known as the American Associa-
tion of Applied Psychology (AAAP) split off from the American
Psychological Association (APA) to provide a home for various
880 Clinical Psychology in North America, History of
professionally oriented groups including the clinical psychol-
ogists, who at this same time dissolved the Clinical Section of
the APA. The AAAP began to publish the Journal of Consulting
Psychology, which subsequently developed into a high-prestige
clinical psychology journal (Routh, 1994).
It was also at this time that some preliminary developments
in psychology began in other parts of North America. In 1937,
for example, the rst psychology curriculum was devised at
UNAM, the National Autonomous University of Mexico, in
Mexico City. In 1939, the Canadian Psychological Association
was founded. It had 38 members to begin with, and it has been
estimated that there were only 53 psychologists in all of Can-
ada at the time. Needless to say, there were few prewar devel-
opments in Canada or Mexico specically relating to clinical
psychology.
The Post-World War II Boom in US Clinical
Psychology
Clinical psychology expanded so greatly in the US after World
War II that many brief historical accounts of the eld even
consider its development to have begun at that time. The war
effort tended to draw everyone into it, either on the battleeld or
on the home front. Many psychologists whose interests prior to
the war had been strictly in research and in the academic side of
the eld found themselves assigned to carry out psychological
testing or to help medical staff in treating psychiatric casualties.
After the war, it was clear that the Veterans Administration (VA)
would have to be vastly expanded to deal with the need for
residential care, psychotherapy, or at least vocational counseling
of some of those returning from military service.
In 1945, the VA and the newly established National Insti-
tute of Mental Health in the US came to the APA to ask it to
establish a system for accrediting training programs in clinical
psychology. The government intended to pour millions of
dollars into training such individuals and needed to know
which programs were competent to carry this out. In response,
APA created a system of accreditation, and for the rst time, it
began to be possible to say who was a well trained clinical
psychologist and who was not. David Shakow (190181) was
the architect of the 1949 conference held in Boulder, Colorado,
which ratied what has come to be called the scientistprac-
titioner model of training clinical psychologists (Raimy, 1950)
(see Training in Clinical Psychology in the United States:
ScientistPractitioner Model).
Postwar clinical psychologists continued in their role as
mental testers, but gave more emphasis to the assessment of
personality and psychopathology, not just cognitive status. This
was the heyday of projective tests, and at least for a time the
Rorschach inkblot was an appropriate symbol for the clinical
practitioner of psychology. A well-known exemplar of the
clinical psychologist as projective tester in this era was David.
Rapaport (191160), chief psychologist at the Menninger
Clinic in Kansas. A two volume set of books published at this
time by Rapaport and coworkers (Rapaport et al., 1945, 1946)
established the Rorschach, the TAT, and the Wechsler test to be
a full test battery for almost a half century to come.
The clinical psychologists of this era were also eager to
become full-edged psychotherapists as well as mental testers.
Their route to therapeutic training was blocked to some extent
by the American Psychoanalytic Associations 1938 policy
decision (contrary to Freuds own views) that only
psychiatrists were to be trained in psychoanalysis. Clinical
psychologists thus became very ingenious in devising ways of
becoming therapists. The best known of them was perhaps
Carl Rogers (190287), whose original therapy supervisor was
the social worker Jessie Taft. Taft, in turn, had received her
training from Otto Rank, a psychologist from Vienna who had
received orthodox psychoanalytic training there and had been
a close colleague of Freuds. Rogers was successfully assertive
in other ways. At one point in his career he was director of
a child guidance clinic when such administrative positions
were supposed to be held only by physicians. Rogers also was
determined to combine his psychology training with his role
as a therapist. He was among the rst to produce recordings
of actual psychotherapy sessions, and was a pioneer in doing
controlled research on the outcome of psychotherapy.
Rogerian therapy (client centered or person centered,
therapy, as it was later called) is still practiced and studied
both in North America and elsewhere (Routh, 1994, 1998).
In 1945, the rst state law certifying psychologists for inde-
pendent practice was passed by Connecticut. By 1977, all states
in the US had passed such certication or licensing laws regu-
lating the use of the title, psychologist or the practice of
psychology (Routh, 1994).
The Behavior Therapy Movement
Some psychologists were of the opinion that clinical
psychologists in their professional activities should not
simply try to duplicate the activities of psychiatrists. In 1913,
John Watson had boldly proclaimed a behavioristic approach
to psychology, which was widely inuential at least in
academic psychology in the US. In a famous paper reporting
research carried out under Watsons supervision, Jones (1924)
described the case of Peter, whose fear of rabbits she
desensitized. Not even Jones herself realized the wider
implications of this study at the time, but in the light of events
many years later some considered her to have been the
mother of behavior therapy (see Behavior Therapy: Psychi-
atric Perspectives).
The behavior therapy movement progressed not only by
following its own agenda but by attacking its opponents.
Psychologist Eysenck (1952) in England thus skeptically
reviewed the evidence for the effectiveness of psychotherapy. It
was not enough, he noted, to show simply that psychotherapy
patients improved. One also needed to consider the rate of
spontaneous improvement of patients who did not receive
psychotherapy.
In 1962 in Charlottesville, Virginia, a behavior therapy
conference was held, sponsored by psychiatrist Joseph Wolpe
and psychologists Andrew Salter and Leo Reyna. At the time
Wolpe had just published a book on his success in treating
patients with phobias using the behavioral method of system-
atic desensitization. Soon afterward, Lang and Lazovik (1963)
published the rst controlled study of desensitization, in treat-
ing snake phobia. Soon the behavior therapy movement was in
full swing, with its own organizations, journals, and many

adherents. Sidney Bijou and his colleagues established behav-
ioral treatments based on the research of B.F. Skinner. These
came to be known as applied behavior analysis and were
especially inuential in work with the behavior disorders of
children and of those with mental retardation (see Behavior
Analysis: Applied).
Canadian Clinical Psychology
It was in the 1960s that clinical psychology nally came of age
in Canada. It was and is the largest applied specialty in
psychology numerically in that country, as it is in the rest of the
world. In 1965, the Couchiching Conference basically endorsed
the Boulder model of scientistpractitioner training for clinical
psychology. Some Canadian doctoral programs such as the one
at McGill even sought accreditation by the American
Psychological Association. There was even something of
a boom north of the border. It is said that by 1966, more
than half the doctoral psychologists in Canada were either
American born or trained in the US. In 1983, the Canadian
Psychological Association established its own program of
accreditation. The rst CPA-accredited doctoral programs in
clinical psychology were those at McGill, Concordia, and
Simon Fraser Universities. The success of doctoral training in
clinical psychology tells only part of the story there, however.
In Quebec and some other eastern provinces, the masters
degree was accepted as the entry level of training for
independent clinical practice. By 1996, Canada had 88
graduate training programs in professional psychology
(including clinical): 57 doctoral and 31 terminal masters.
Canadian clinical psychology is noted for particular strength
in the area of neuropsychology, which built on Canadian
strengths in the neurosciences, including the work of neuro-
surgeon Wilder Peneld at the Montreal Neurological Institute.
In academic psychology, the research and writings of Donald
Hebb concerning the CNS (conceptual nervous system) were
inuential. It was at McGill University that Olds and Milner
published their famous 1954 paper on the reinforcement of an
animals behavior by electrical stimulation of its brain. On the
clinical side, Ronald Melzack elaborated his theory of gating
mechanisms inuencing the experience of pain. Brenda Milner
explored the role of the hippocampus in semantic memory,
including work with her famous patient, H.M. This man
developed permanent memory decits after surgery inadver-
tently destroyed his hippocampus bilaterally. Doreen Kimura
documented the left cerebral hemisphere advantage in dichotic
listening.
Clinical Psychology in Mexico
In 1997, the Division of Clinical Psychology of the APA held its
midwinter board meeting in Mexico City, hosted by Juan Jose
Sanchez-Sosa, the director of the school of psychology at UNAM,
the National Autonomous University of Mexico. Sanchez-Sosa
provided his US colleagues with a tour of this school, itself as
large as many an entire college campus in the US. The school
offers both Masters and PhD degrees in psychology, but as in
much of Europe, these degrees are intended for those headed
Clinical Psychology in North America, History of 881
for academic and research careers. Those who intend to
practice psychology, including clinical psychology, in Mexico
need only a licentiate or diploma to do so, which is awarded
after 6 years of what to persons trained in the US seems to be
undergraduate training. But students in such a program spend
essentially full time on psychology, without the need for
a broad liberal arts distribution of courses. This includes
a signicant amount of practicum experience. The psychology
clinic, one of the practicum facilities used at UNAM, features
a variety of clinical activities, including psychological testing,
psychodynamic therapy, behavior therapy, group therapy, and
even biofeedback. Since there is no certication or licensing
system beyond the licentiate degree itself, it is difcult to be
sure how many of these graduates are practicing clinical
psychology in a way parallel to what would be seen in the US
or Canada.
Independent Practice of Clinical Psychology
Although Lightner Witmer in his clinical work often collabo-
rated with school teachers, physicians, or others, psychologists
working in his clinic were never supervised by members of any
other profession. This tradition of independent work has
continued within the eld of clinical psychology, somewhat in
contrast with social work and nursing. The post-World War II
expansion of the eld in the US was primarily in the public
sector, typically VA hospitals, but also child guidance centers
and eventually community mental health centers. The large
government training grants supporting clinical psychology
programs at the time presupposed that the graduates would
go to such public sector jobs or teach in colleges and
universities. In the 1980s, the Reagan administration made
most such training grants a thing of the past (Routh, 1994).
David Mitchell, a PhD student of Lightner Witmer, was one
of the rst individuals to make his living primarily in the private
practice of psychology. Eventually, he was joined by many
others. After all, the state and provincial laws that developed to
regulate psychology after 1945 specied what qualications
were necessary to offer ones services to the public as
a psychologist. Many psychologists trained in Boulder-model
PhD programs did no research after graduation, and eventually
the idea of training psychologists as practitioners rather than
scientistpractitioners emerged. Beginning with the University
of Illinois in 1966, a number of programs began to offer the
doctor of psychology (Psy.D.) degree rather than the PhD The
conference in Vail, Colorado in 1973 ofcially legitimized
such practitioner training for the rst time. In fact, a number
of nonuniversity-afliated schools of professional psychology
sprang up beginning in the 1970s, many of them offering
Psy.D. degrees. Often these programs were supported only by
student tuition, and many students assumed substantial loans
to nance their education (Routh, 1994). No such private
school of professional psychology has emerged in Canada
(nor in Mexico) (see Training in Clinical Psychology in the
United States: Practitioner Model).
As psychologists in private practice emerged in larger
numbers, they also became more active politically. The rst
practitioner became president of the APA in 1977, and
within 20 years the rst Psy.D. was elected to this position.
882 Clinical Psychology in North America, History of
The practitioners began to dominate both the APA and the
Canadian Psychological Association to a greater and greater
extent. In response, many academic psychologists retreated
to form national organizations of their own that were more
research-oriented. Thus, the American Psychological Society
was founded in 1988. Similarly, in 1989, academic and
research psychologists in Canada founded the Canadian
Society for Brain, Behavior, and Cognitive Science.
Practicing psychologists both in the US and Canada battled
psychiatrists for their share of the mental health market. Thus,
they fought to obtain hospital privileges. They supported
freedom of choice legislation to become eligible as health
providers reimbursable by health insurance companies and
Health Maintenance Organizations. In 1988, a law suit by
clinical psychologist Bryant Welch and others forced the
American Psychoanalytic Association to begin to admit
psychologists for training at its local institutes (Routh, 1994).
Most recently, a number of practicing psychologists in the US,
led by Patrick DeLeon, have been trying to obtain the right to
prescribe medications for mental health conditions, so far
without much success.
The Continued Commitment of Clinical Psychology
to Research
Well before the founding of Witmers clinic, there was
a strong interest on the part of psychology in research on
psychopathology, including its diagnosis and treatment. This
continues to be the case. In fact, psychologists are far more
likely than psychiatrists or those in other elds to be prin-
cipal investigators on research grants from the National
Institute of Mental Health. Such research is international in
scope and is a collaborative interdisciplinary enterprise. The
turf battles that characterize the marketplace of practice are
much less typical in the research arena, where clinical
psychologists often cooperate smoothly with experimental
psychologists and statisticians as well as with medical
colleagues. In research, it is neither possible nor necessary to
draw any bright line to show the boundaries between these
elds.
The diversity of such research is so great that it would be
impossible to cover it in an article as brief as this one. Instead,
a few examples must sufce. In 1954, psychologist Evelyn
Hooker received her rst NIMH grant to study homosexuality.
Her work, much of it using the types of projective testing that
were typical of clinical psychological work at the time, suggested
that homosexuals might be essentially normal psychologically.
This research was related to the later decisions to delete
homosexuality as a pathological category from the Diagnostic
and Statistical Manual of the APA.
In the 1950s, psychologist Leonard Eron began collecting
peer-rating data on aggressive behavior in 8-year-old children.
The subsequent longitudinal research he and his colleagues
did helped establish the fact that aggressive behavior is highly
stable well into adulthood. Psychologist Gerald R. Patterson
studied aggressive behavior in children using direct behavioral
observations, relating it to coercive processes in the parent
child dyad and doing controlled intervention studies showing
how it could be reduced.
In the late 1950s, psychologist C. Keith Conners devised
a simple teacher rating scale for the assessment of varied types
of disordered behavior in school children. Together with child
psychiatrist Leon Eisenberg he helped carry out the rst
controlled studies of the effects of stimulant medications on
childrens disruptive behavior (Conners and Eisenberg, 1963).
Such research formed an important basis of present concepts
of Attention Decit Hyperactivity Disorder, the most
commonly diagnosed type of child psychopathology and one
still typically treated with stimulant medications. By the
1970s, Thomas Achenbach and his colleagues had begun to
develop the use of parent, teacher, and self-ratings for child
behavior into the most widely used forms of assessment by
mental health workers.
In 1962, Meehl published a classic paper on schizo-taxia,
schizotypy, and schizophrenia, elaborating his concepts as to
how genetic factors might be involved in the development of
this disorder (Meehl, 1962). In 1973, psychologist Holzman
and coworkers announced their discovery of smooth pursuit
eye-movement difculties in patients with schizophrenia
(Holzman et al., 1973). This neurological symptom proved to
be an important trait marker in the rst degree relatives of
schizophrenics as well, whether or not they manifested any
overt psychopathology. In Denmark, psychologist Sarnoff A.
Mednick carried out a series of studies using the excellent
public registers that characterize that country to do
longitudinal, epidemiological studies of schizophrenia,
implementing the type of research that Meehl had only been
able to imagine.
Problems of the dysregulation of affect and emotion are the
most ancient in the eld of psychopathology, having been with
us since Hippocrates. Beginning in the 1960s, psychologist
Richard Lazarus elaborated his concepts of stress, appraisal, and
coping and demonstrated experimentally how his subjects use
of different coping strategies could dampen or heighten their
physiological stress (Lazarus, 1966). Beginning in the 1970s,
Charles Spielberger and his colleagues began the development
and validation of measures of state as well as trait anxiety and
later of state and trait anger as well. In the 1970s, Martin E.P.
Seligman and his colleagues showed how his studies of learned
helplessness in dogs could be used to reconceptualize human
depression.
In conclusion, clinical psychology has both international
and important North American roots. In its rst century, it has
developed into a viable science and profession, and there is
good reason to suppose that its trajectory will continue in the
twenty-rst century.
See also: Clinical Psychology in Europe, History of;
Psychoanalysis, History of; Psychotherapy, History of:
Psychiatric Aspects; Training in Clinical Psychology in the
United States: Practitioner Model; Training in Clinical
Psychology in the United States: ScientistPractitioner Model.
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