History of clinical psychology

• County Asylums Act - first mental health legislation in the UK


  1808
• The County Asylums Act provided authorities to provide care for 'pauper lunatics' to remove them from workhouses and prisons, but there was no treatment available for mental illness
• Those in Asylums were displayed to show what 'crazy' looked like
• Lunatic Asylums


  Created as places of safety for the mad and the poor (Asylum → place of refuge)
• The Lunacy Act changed the status of the mentally ill from 'inmates' to 'patients', growing assumption that madness was a treatable disease


  1845
• By the 1850s there was broad agreement on the division of 'psychiatric conditions' into neuroses and psychoses
• Neuroses


  Disorders which affected mood, and self-esteem, associated with fear, anxiety and panic
• Psychoses


  Disorders which affected reason and the individual's grasp of reality, associated with delusions and hallucinations
• Emile Kraepelin


  Revolutionised the taxonomy of 'madness', emphasised syndrome (symptom patterns) rather than single symptoms, refined separation of neurotic and psychotic conditions, divided the psychoses into dementia praecox and manic-depressive illness
• DSM-3 (1980)


  Diagnostic and Statistical Manual of the APA - 3rd edition, a radical revision that lists conditions regarded as mental disorders and criteria required to diagnose them, adopts Kraepelinian schema
• Psychiatric treatments

  • Psychoses: hospitalisation, coma

  Neuroses: psychodynamic therapy, hypnosis, sedatives, psychosurgery, ECT

  Psychopharmacological revolution (1945-1965): lithium, phenothiazines, tricyclic antidepressants, benzodiazepines
• Issues with psychiatric drugs include physical and psychological side effects, addiction/withdrawal, and overprescribing
• The Boulder Model


  APA model that emphasised 3 roles for clinical psychologists: diagnosis, research, and therapy (psychodynamic)
• Institute of Psychiatry (King's College London) commences a programme of training in 'clinical psychology'


  1957
• A BPS 'Division of Clinical Psychology' (DCP) formed, syllabus for a Diploma in Clinical Psychology developed


  1966
• British Journal of Clinical Psychology launched

  1981
• BPS / DCP agreed that all Clinical Psychology training should be 3 years (to doctorate) by 2000

  1990
• First Doctoral programmes in clinical psychology accepted students

  1995 / 1996
• From 1945-1970, the early role of UK clinical psychology was dominated by assessment and research, with little contribution to 'therapy'
• Eysenck's (1949) view of the clinical psychologist


  The psychiatrist is responsible for therapy, the psychologist for diagnosis help and research design, the social worker for investigation of the social consideration
• Progressive muscle relaxation


  Method introduced by Edmund Jacobson, based on research into muscle tension into mental (anxiety) states, amplifies the experience of relaxation, modifies the experience of anxiety
• Talking therapies offered a 'revolutionary' approach to treating mental disorder
• Psychoanalysis and studies on hysteria


  Impressed by the success of Josef Breuer's approach to the treatment of 'Anna O', the patient later described the approach as her "talking cure", Freud eventually developed the approach as 'Psychoanalysis'
• Rational emotive behaviour therapy (REBT)


  Developed by Albert Ellis, human distress doesn't arise because of 'unfortunate' events and circumstances, it arises from irrational and dysfunctional thoughts, feelings, and beliefs attributed to those events and circumstances, emphasised the A-B-C model of distress
• Systematic desensitisation


  First to use principles of classical / operant conditioning to treat anxiety states → phobias, developed through 'reciprocal inhibition', published 'The Practice of Behaviour Therapy' in 1969
• Cognitive therapy


  Developed by Aaron T. Beck, how we think about a situation determines how we subsequently feel about it, typical patterns of thinking → cognitive schemas, negative schemas can become 'automatic', producing habitual negative emotions, directly addressing errors → cognitive restructuring, indirectly addressing errors → distraction or blocking strategies
• Cognitive and behavioural therapies


  • Both symptomatic psychotherapies (non-exploratory), both suited to 'brief intervention' models (4-8 clinical sessions), both effective in the treatment of mental AND physical health problems, both enthusiastically adopted by clinical psychology in the 1980s
• Morphing CBT (1980-2000)


  CBT → the pragmatic combination of cognitive and behaviour therapies, from a treatment delivery perspective, more similarities than differences, fusion supported by evidence of efficacy
• Mental Health Act - those in charge of patient treatment changed from 'responsible medical officer' (RMO) to 'responsible clinician' (RC), the RC does not need to be a consultant psychiatrist, but must be an approved clinicial (AC), with appropriate training, clinical psychologists are eligible for AC / RC roles

  2007
• Evidence based practice


  Using the best available evidence in deciding whether a given treatment works, and for whom it works, using the best available evidence to decide which of 2 (or more) treatment options is most effective and affordable, commits clinical psychology to an ongoing programme of controlled outcome assessment, makes psychological therapies a continuing 'work in progress'
• Roth and Fonagy's (2004) "what works for whom?" provides a landmark in evidence synthesis
• The National Institute for Health and Care Excellence (NICE)


  Founded in 1999 as an arm of the department of health, using methods of systematic review and evidence appraisal, aims to improve health and social care through evidence-based guidance, NICE guidance has become very influential in determining which therapies are appropriate (and which therapies should be commissioned) within the NHS
• As a scientist-practitioner enterprise, clinical psychology both generates evidence and adjusts clinical practice in line with results
• Health Education England People Plan 2020-2021 prioritises continued investment to support significant expansion in psychological therapies, increasing the number of training places for clinical psychology and child and adolescent psychotherapy by 25%