History Of Clinical Psychology In North America Research Paper

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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 field usually dates its origin from the founding of the first 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 field developed in French-speaking Canada and in Mexico in a way more resembling that of European countries, with master’s or licenciate-level training required for independent practice. The North American Free Trade Agreement (NAFTA) 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 qualified clinical psychologists.

1. 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 literatures 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 them-selves (Routh 1998).

2. Greek Ideas Concerning Psychopathology

Western concepts of psychopathology have their roots in those of the ancient Greeks, including the writings attributed to the physician Hippocrates (460–377 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 Hippocratic 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 inflammation 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 reflecting why some of them lasted well into the eighteenth century and beyond.

3. Emergence Of Psychiatry

Although according to Herodotus (ca. 484–425 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 (1745–1826), Benjamin Rush (1745–1823), and Vincenzo Chiarugi (1759– 1820), it was associated with the development of mental asylums or hospitals 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.

4. Modern Psychology And The Study Of Psychopathology

Long before a formal discipline of psychology existed, people in every society still no doubt reflected upon human experience and behavior. As was the case of Hippocrates in relation to medicine and psychiatry, the influence of ancient Greek philosophers such as Plato (427–347 BC) and Aristotle (384–322 BC) upon our present psychological concepts was pervasive. There is conventional agreement that psychology emerged as a formal academic discipline only in the mid-nineteenth century in Europe. Wilhelm Wundt (1832–1920) of the University of Leipzig is usually named as the founder of the field, and 1879, the year in which he set up his psychology laboratory there, is celebrated as the key event in its origin. Wundt’s 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 (1856–1926) was influenced by Wundt’s 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 laboratories 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 (1839–1916), who wrote about diseases of memory and about personality disorders. An important French colleague was Pierre Janet (1859–1947), who studied anxiety, hysteria, and obsessions and developed concepts of dissociation that continue to be influential today. In the US the leading pioneer in psychology, William James (1842– 1910) was originally trained in medicine but wrote a psychology textbook that proved to be the most influential of all. In 1896, James gave his Lowell lectures on exceptional mental states, much influenced by the work of Janet. Boston neurologist Morton Prince also became interested in Janet’s writings and published a description 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 Association. Subsequently, in 1926, he established the Harvard Psychological Clinic, which was a research facility rather than one delivering mental health services. The most influential medically trained student of psychology of this time was no doubt Sigmund Freud (1856–1939). Breuer and Freud’s book Studies in Hysteria, was published in 1895 and Freud’s book on the interpretation of dreams in 1900. The first international psychoanalytic meeting was held in Salzburg in 1908. In 1909, Freud came to the US for the first and only time.

5. Lightner Witmer And Clinical Psychology

As the above paragraphs make clear, Witmer was hardly the first 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 Ph.D. under Wundt, served as a school teacher. He had as a student a young man with marked difficulty 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 Ph.D. 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 field of clinical psychology launched.

Witmer’s clinic worked more with children than with adults and tended to concentrate on academic difficulties 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 eighteenth and nineteenth century French physicians and special educators such as Jacob Pereire (1715–1780) (who taught deaf-mutes to speak), J. M. G. Itard (1775– 1838) (who worked with the ‘wild boy’ of Aveyron), and Edouard Seguin (1812–1880) (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 form-board 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 collaborated with school teachers, as well as with physicians, thus serving as more of a consultant than doing anything resembling present-day psychotherapy. As a matter of fact, he was little influenced 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 scientific discoveries but rather for his persistence in enacting this new role of the clinical psychologist. At the University of Pennsylvania’s Ph.D. program, he essentially trained most of the first 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).

6. The Binet Test

There is still no consensus among psychologists as to precisely how to interpret its findings. Still, Alfred Binet’s ‘metric scale’ of intelligence (Binet and Simon 1905) may be the most noteworthy piece of technology developed by psychology in its first century. Certainly it had a major impact on the new field 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 field, 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 influential his test was, it is interesting to note that Alfred Binet himself was not particularly identified with the field of clinical psychology. Originally trained as a lawyer, Binet became part of the circle around the influential neurologist Jean Charcot at the Salpetriere in Paris. Much of his psychology was self-taught, through extensive reading at the Bibliotheque Nationale. In France, Binet became known as one of the founders of the entire field of psychology (often characterized worldwide as ‘experimental psychology’) and edited the influential journal, Annee psychologique. As is well known, Binet’s successful attempts to devise an intelligence test departed from the conventional approach of using relatively ‘pure’ sensory and motor tasks to use complex work-samples of the kinds of things school-children might be expected to know and do.

For some reason, Binet’s 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 confirmed its impressive validity in identifying persons with mental retardation. The use of the Binet spread like wildfire among the early clinical psychologists in the US, beginning with those employed in the field of mental retardation. Goddard founded the first psychology internship in 1908 at Vineland, NJ. Goddard went on to become the first professor of clinical psychology at Ohio State University, like the University of Pennsylvania an important early training center in the field (Routh 1994).

Lewis M. Terman (1877–1956) at Stanford University developed a standardized version of Binet’s test, collected normative data for it, and introduced certain refinements such as the ratio IQ score (originally suggested by Wilhelm Stern of Hamburg). The 1916 Stanford–Binet, as it was called, dominated this field for many years. At about the same time, 1915, Robert Yerkes pointed out the unsuitability 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 war-time development was Robert S. Woodworth’s Personal Data Sheet published in 1917. This was one of the first rationally developed self-report questionnaires intended to detect neurotic tendencies (Routh 1994).

7. The Child Guidance Center Movement

The development of child guidance centers was an-other factor that influenced early clinical psychologists in the direction of working with children more than with adults. The first child guidance clinic was the Institute of Juvenile Research, established 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 first by clinical psychologist Grace Fernald and subsequently by her replacement, Augusta Bronner (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 family’s philanthropy in the form of the Commonwealth Fund and replicated in many US cities and abroad.

8. 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 (AACP) and invited 48 colleagues to join them (Routh 1994). They were led by J. E. W. Wallin (1876–1969) and Leta Hollingworth (1886–1939). Incidentally, Hollingworth was the first 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 qualified clinical psychologists failed, however.

9. 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 (1884–1922) 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 (1896–1976). Beck then proceeded to do his dissertation on this new test and eventually to develop his own system for administering and scoring it. Psychologist Bruno Klopfer (1900–1971), a disciple of Carl Jung (1875–1961), also introduced the Rorschach to the US and developed a separate system for administering and scoring it. 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 (1889–1969), 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 retardation. David Wechsler (1896–1981) published the original version of his Wechsler–Bellevue intelligence test for adults. This was but the first 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 first edition of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI had novel ‘validity’ indicators, and its measures of psychopathology were empirically keyed to psychiatrically defined groups.

10. Organizational Activities

In 1937 a new organization known as the American Association of Applied Psychology (AAAP) split off from the American Psychological Association (APA) to provide a home for various professionally oriented groups including the clinical psychologists, 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 first 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 Canada at the time. Needless to say, there were few prewar developments in Canada or Mexico specifically relating to clinical psychology.

11. 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 field even consider its development to have begun at that time. The war effort tended to draw everyone into it, either on the battlefield 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 field 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 Institute 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 first time, it began to be possible to say who was a well-trained clinical psychologist and who was not. David Shakow (1901–1981) was the architect of the 1949 conference held in Boulder, Colorado, which ratified what has come to be called the ‘scientist–practitioner’ model of training clinical psychologists (Raimy 1950).

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 (1911–1960), chief psychologist at the Menninger Clinic in Kansas. A two volume set of books published at this time by Rapaport and co-workers (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-fledged psychotherapists as well as mental testers. Their route to therapeutic training was blocked to some extent by the American Psycho-analytic Association’s 1938 policy decision (contrary to Freud’s 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 (1902–1987), 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 Freud’s. 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 first 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 first state law certifying psychologists for independent practice was passed by Connecticut. By 1977, all states in the US had passed such certification or licensing laws regulating the use of the title, ‘psychologist’ or the practice of psychology (Routh 1994).

12. 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 influential at least in academic psychology in the US. In a famous paper reporting research carried out under Watson’s supervision, Jones (1924) de-scribed 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.’

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 systematic desensitization. Soon afterward, Lang and Lazovik (1963) published the first controlled study of desensitization, in treating 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 behavioral treatments based on the research of B. F. Skinner. These came to be known as applied behavior analysis and were especially influential in work with the behavior disorders of children and of those with mental retardation.

13. Canadian Clinical Psychology

It was in the 1960s that clinical psychology finally 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 scientist–practitioner training for clinical psychology. Some Canadian doctoral pro-grams 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 pro-gram of accreditation. The first 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 master’s degree was accepted as the entry level of training for in-dependent clinical practice. By 1996, Canada had 88 graduate training programs in professional psycho-logy (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 neurosurgeon Wilder Penfield at the Montreal Neurological Institute. In academic psychology, the research and writings of Donald Hebb concerning the CNS (conceptual nervous system) were influential. It was at McGill University that Olds and Milner published their famous 1954 paper on the reinforcement of an animal’s behavior by electrical stimulation of its brain. On the clinical side, Ronald Melzack elaborated his theory of gating mechanisms influencing 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 deficits after surgery inadvertently destroyed his hippocampus bilaterally. Doreen Kimura documented the left cerebral hemisphere advantage in dichotic listening.

14. 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 Master’s and Ph.D. degrees in psychology, but as in much of Europe, these degrees are intended for those headed 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 significant 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 certification or licensing system beyond the licentiate degree itself, it is difficult 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.

15. Independent Practice Of Clinical Psychology

Although Lightner Witmer in his clinical work often collaborated 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 field of clinical psychology, somewhat in contrast with social work and nursing. The post-World War II expansion of the field 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 Ph.D. student of Lightner Witmer, was one of the first 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 specified what qualifications were necessary to offer one’s services to the public as a psychologist. Many psychologists trained in Boulder-model Ph.D. programs did no research after graduation, and eventually the idea of training psychologists as practitioners rather than scientist–practitioners 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 Ph.D. The conference in Vail, Colorado in 1973 officially legitimized such practitioner training for the first time. In fact, a number of nonuniversity-affiliated 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 finance their education (Routh 1994). No such private school of professional psychology has emerged in Canada (nor in Mexico).

As psychologists in private practice emerged in larger numbers, they also became more active politically. The first practitioner became president of the APA in 1977, and within 20 years the first Psy.D. was elected to this position. 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 Psycho-logical Society was founded in 1988. Similarly, in 1989, academic and research psychologists in Canada founded the Canadian Society for Brain, Behaviour, 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 (HMOs). 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.

16. The Continued Commitment Of Clinical Psychology To Research

Well before the founding of Witmer’s 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 fields to be principal 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 fields.

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 suffice. In 1954, psychologist Evelyn Hooker received her first 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 first controlled studies of the effects of stimulant medications on children’s disruptive behavior (Conners and Eisenberg 1963). Such research formed an important basis of present concepts of Attention Deficit Hyperactivity Disorder (ADHD), 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 co-workers announced their discovery of smooth pursuit eye-movement difficulties in patients with schizophrenia (Holzman et al. 1973). This neurological symptom proved to be an important ‘trait’ marker in the first 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 field 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 inter-national and important North American roots. In its first 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-first century.

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