➔ Approaches of Clinical Psychology?

● The term Clinical Psychology was first used in print by

Lightner Witmer in 1907. Witmer was also the first to operate
a psychological clinic. Witmer envisioned clinical psychology
as a discipline with similarities to a variety of other fields,
specifically medicine, education, and sociology. At his clinic,
the first clients were children with behavioral or educational
problems. However, even in his earliest writings, Witmer
(1907) foresaw clinical psychology as applicable to people of
all ages and with a variety of presenting problems.
★ The Division of Clinical Psychology (Division 12) of the
American Psychological Association (APA) defines clinical
psychology as follows:
“The field of Clinical Psychology integrates science, theory,
and practice to understand, predict, and alleviate
maladjustment, disability, and discomfort as well as to
promote human adaptation, adjustment, and personal
development. Clinical Psychology focuses on the
intellectual, emotional, biological, psychological, social, and
behavioral aspects of human functioning across the life
span, in varying cultures, and at all socioeconomic levels.”

● After World War II, clinical psychology grew rapidly,

branching out into the major theoretical approaches that came
 to define the field: psychodynamic, humanistic, behavioral,
cognitive, systems, and biological. Each of these approaches
is best thought of as a broad school of thought rather than a
single theory:-

A. The Psychodynamic Approach-

Freud’s psychodynamic theory was founded on the idea that
human behavior is derived from the constant struggle between
the individual’s desire to satisfy inborn sexual and aggressive
instincts and the need to respect the rules and realities imposed
by the outside world. This conflict often leads to anxiety
against which the a person tries to build defenses. If the
anxiety gets too strong, or if the defenses become ineffective,
a variety of psychological symptoms can appear. Freud
employed the terms id, ego, and superego to represent the
aspects of the mind that are often in conflict.
Basic Concepts:-
1. Human behavior is determined by impulses, desires,
motives, and conflicts that are often out of awareness.
2. Psychological problems typically occur because clients
unsuccessfully defend against the unconsciously replay of
internal (or intrapsychic) conflicts that were originally
experienced in childhood relationships with family, peers,
and authorityfigures.
 3. Clinical assessment, treatment, and research should
emphasize the aspects of intrapsychic activity that must be
uncovered if behavior is to be understood and behavior
problems are to be alleviated.
4. The goals of psychotherapy are to improve ego functioning
and to help clients recognize and change the ways they
inappropriately repeat the past.
5. With the therapist’s help, the client gradually becomes
aware of how historically rooted conflicts, pushed (not quite
successfully) into the unconscious, have come to be expressed
in current experience. This awareness, called insight, is a
central goal in psychoanalytic treatment.

B. The Humanistic Approach-

The humanistic approach views persons as creative, growthful
beings who, if all goes well, consciously guide their own
behavior toward realization of their fullest potential as unique
individuals. When behavior disorders arise, they are usually
seen as stemming from disturbances in awareness or
restrictions on existence that can be eliminated through various
therapeutic experiences. Treatment approaches aimed at
addressing and correcting these problems are also known as
phenomenological or experiential therapies.
The roots of humanistic therapies are in the clinical tradition,
but they also grow from the philosophical position of
phenomenology, which states that behavior is determined by
the perceptions and experiences of the behaving person.
Phenomenology puts the client’s perceptions and experiences
at the center of therapy—what the client perceives, feels, and
thinks in the here-and-now takes center stage. Childhood
history buried in the unconscious may have played a formative
role, but the client’s current experiences of reality (including
experiences of the self) are what matter most. Perhaps the
most prominent advocate of humanistic psychology was
Carl Rogers, a psychologist who was initially trained in
psychoanalysis. Rogers’s most important contributions have
been his emphasis on empathic listening on the part of the
therapist and on the quality of the therapist– client relationship.
Basic Concepts-
1. Humanistic psychologists view human nature as essentially
positive and believe that their clients’ lives can be understood
only when seen from the point of view of those clients.
2. Humanistic psychologists believe problems develop when a
person tries to avoid experiencing emotions that are confusing
or painful—such avoidance causes the person to become
alienated from, and unaccepting of, his or her true self.
 3. Therapists treat clients as responsible individuals who are
experts on their own experiences and who must ultimately be
the ones to make decisions about their lives.
4. Humanistic therapists view the therapeutic relationship as
the primary vehicle by which therapy achieves its benefits.
Focusing on the immediate, moment-to-moment experiences
in an atmosphere of honesty and acceptance is what helps
clients perceive themselves more positively.

C. The Behavioral Approach-

Groundwork for the emergence of behavior therapy occurred
in the 1920s, when psychologists became interested in
studying the role of conditioning and learning in the
development of anxiety. The discovery of “experimental
neuroses” in animals led to research on similar problems in
humans.The most famous of these studies was an experiment
in 1920 by J.B. Watson and his graduate student, Rosalie
Rayner. A 9-month-old infant, Albert B., was presented with
several stimuli such as a white rat, a dog, a rabbit, a monkey,
masks, and a burning newspaper. He showed no fear toward
any of these objects, but he did become upset when a loud
noise was sounded by striking a steel bar with a hammer.To
see whether Albert’s fear could be conditioned to a harmless
object, Watson and Rayner associated the loud noise with
a tame white rat. Albert was shown the rat, and as soon as he
began to reach for it, the noise was produced. After several
pairings, the rat alone elicited a strong emotional reaction in the
child. A few years later, Mary Cover Jones, another of
Watson’s students, investigated several techniques for
reducing children’s. E.g.- she used social imitation to help
a 3-year-old named Peter conquers his fear of rabbits.
The cases of Albert and Peter encouraged the application of
conditioning principles to the treatment of fear and many
other disorders; the 1920s and 1930s saw learning-based
treatments for sexual disorders, substance abuse, and various
anxiety-related conditions. The term behavior therapy first
appeared in a 1953 paper that described the use of operant
conditioning to improve the functioning of people with
chronic schizophrenia (Lindsley, Skinner, & Solomon,1953).
In the years since, numerous behavioral techniques have been
developed for the treatment of psychological disorders.
Basic Concepts
1. Behavioral psychologists view human behavior as learned
through conditioning and observation.
2. Psychological problems are assumed to be learned and
specific to situations or classes of situations.
3. Behavior therapy focuses on changing variables that
maintain situation-specific learned maladaptive responses.
 4. Behavior therapy is derived from empirical research and
stresses collection of data to evaluate treatment effectiveness.

D. The Cognitive Approach-

Cognitively oriented researchers and therapists view certain
cognitions, particularly thoughts about the self, especially
important in the development of psychological disorders.
Because these thoughts are usually connected to emotions,
they affect how persons feel about themselves and their
relationships with others. Cognitive therapists attempt to
modify maladaptive behavior by influencing a client’s
cognitions: beliefs, schemas, self-statements, assumptions,
expectations and problem-solving strategies.
George Kelly was arguably the first cognitive clinical
psychologist. He developed a theory based on fundamental
assumption that human behavior is determined by personal
constructs, or ways of anticipating the world. According to
his theory, disordered behavior results when a person develops
inaccurate, oversimplified, or otherwise faulty constructs about
social experiences.
Another influential figure in the cognitive approach was
Albert Ellis. The core principle of his rational-emotive
therapy is evident in this quote:
When a highly charged emotional Consequence (C) follows a
significant Activating Event (A), A may seem to but actually
does not cause C. Instead, emotional Consequences are largely
created by B—the individual’s Belief System. When,
therefore, an undesirable Consequence occurs, such as severe
anxiety, this can usually bequickly traced to the person’s
irrational Beliefs, and when these Beliefs are effectively
Disputed (at point D), by challenging them rationally, the
disturbed Consequences disappear and eventually cease to
reoccur. The therapist’s task is to attack these irrational,
unrealistic, self-defeating beliefs and to instruct clients in more
rational or logical thinking patterns that will not upset them.
Other versions of cognitive therapy,like that of Aaron Beck
(1976), provided detailed accounts of how specific types of
thoughts influence specific disorders, such as depression.
They are all related to theories that describe the connections
between cognitive processes and social behaviour.
Basic Concepts
1. Behavior develops not only from learned connections b/w
stimuli and responses but also from how individuals think
about events.
2. Individuals develop their own idiosyncratic ways of
understanding events that affect them, and those explanations
affect how they feel and behave.
 3. Psychological problems can develop when people’s
beliefs contribute to the things they most fear—for instance,
when a depressed person’s belief that she is not liked causes
her to be uncommunicative which in turn causes others to
see her as unapproachable (a faulty feedback loop).
4. Therapists engage clients in a rational examination of their
beliefs, encouraging them to test their hypotheses, explore
alternate beliefs, and practice applying alternate beliefs.

E. The Cognitive-Behavioral Approach-

Around 1960s and 1970s, there were signs of a truce between
the behavioral and cognitive camps. Behaviorally oriented
therapists recognized the importance of cognitions in various
disorders, and cognitively oriented therapists recognized the
importance of translating cognitive change into behavior
change. Albert Ellis, for instance, understood the importance
of focusing on specific behaviors (in addition to irrational
beliefs); he eventually changed the name of his treatment
approach from rational-emotive therapy to rational-emotive
behavior therapy (Ellis, 1993).
There were other reasons for combining behavioral and
cognitive approaches to therapy. Both of them are focused on
treating specific aspects of functioning, both had come from
the empirical tradition in clinical psychology, and both
 emphasized well-controlled research to test their underlying
theories, assessment techniques, and psychotherapy outcomes.
The result was that the two forms of therapy, originally
distinct, are now typically taught and practiced together as
cognitive-behavioral therapy, or CBT. Cognitive-behavioral
therapy refers to a family of therapy techniques and approaches
originally developed as either behavioral or cognitive. It now
also includes refinements and integrations that were developed
using both behavioral and cognitive principles.

F. Group, Family, Marital, Couples, and Systems

Approaches-
A number of alternatives to the psychodynamic, humanistic,
and cognitive-behavioral approaches developed during the
latter half of the 20th century. Many of these alternatives
shared the view that people’s behavior develops in, and is
a reflection of the relationship systems in which they live.
These approaches, which we call group or systems approaches,
emphasize interventions directed at a group or pair of
interacting people rather than just an individual.
One of the earliest of these approaches is embodied in
group therapy, which was first practiced at the beginning
of the 20th century in Boston by Joseph Pratt. Later,
stimulated by the shortage of professional personnel around the
time of World War II, group therapy became a practical answer
to a surplus of clients (typically soldiers and veterans) and
a shortage of clinicians.
Around the middle of the last century, family therapy
developed as clinical child psychologists realized they could
treat children’s behavior problems more effectively if parents
were involved.
Closely allied with the family therapy movement was the
marital therapy movement. The first marital therapists were
often obstetricians, gynecologists, clergy, social workers, and
educators. Conjoint marital therapy (treating both partners at
the same time) by clinical psychologists did not become
commonplace until well into the 1970s. Initially, clinical work
focused mostly on helping couples adjust to culturally accepted
marital roles and giving advice about practical aspects of
marriage such as sexuality and parenting,
Basic Concepts
1. Human behavior develops in, and is maintained by, social
contexts.
2. The interlocking system of roles, beliefs, behaviors, and
feedback mechanisms can function well or poorly.
3. Group, family, and marital therapists focus on and attempt
to influence specific patterns of interaction and exchange that
have significance for individuals in the system.
G. The Biological Approach-
Recent research in neuroscience,experimental psychopathology
,behavioral genetics, and related areas has made clinicians
aware that behavioral and mental processes rest on a
foundation provided by each person’s biological makeup. This
makeup includes genetically inherited characteristics as well
as the activity of the brain and other organs and systems that
underlie all kinds of behavior and mental processes, both
normal and abnormal.
Biological factors can influence mental disorders in various
ways. Sometimes, the influence is direct, as when alcohol
or other drugs cause intoxication, when degeneration of
neurons in certain areas of the brain causes Alzheimer’s
disease, and when genetic abnormalities cause particular
forms of intellectual disability. Other disorders can result
from more than one cause, only some of which involve
biological factors. Such multiple pathways to disorder are
suspected in the appearance of various subtypes of depressive
disorders, anxiety disorders, schizophrenia, and personality
disorders.
The finding of biological contributions to disorders does not
automatically negate the value of psychological treatments.
Thus, even if a child’s hyperactivity is traced to a neurological
defect, a solution might be provided by CBT instead of, or
 in addition to drugs. In short, recognizing the importance of
biological variables in psychopathology does not render
traditional approaches to clinical psychology irrelevant;
indeed, it deepens and expands their range of inquiry.

➢ The foundations of psychodynamic and behavioral

approaches to clinical psychology developed well before
World War II, but after the war, when treatment became a
central activity for clinicians, these approaches surged. Other
approaches to treatment soon developed: humanistic,
cognitive, group/systems, and hybrid approaches such as
cognitive-behavioral. These “schools” dominated clinical
psychology, shaping theory and practice during the field’s most
rapid period of development. They continue to exert strong
influence today.

➔ Clinical Intervention: Biological

Therapies, ECT and Chemotherapy
Clinical interventions occur when clinicians, acting in a
professional capacity, attempt to change a client’s behavior,
thoughts, emotions, or social circumstances in a desirable
 direction. Intervention can take many forms, including
individual and group psychotherapy, biological therapy,
psychosocial rehabilitation and prevention. Here we are going
to discuss some biological therapies:-
Biological therapies are treatments designed to reduce
psychological disorder by influencing the action of the central
nervous system. These therapies primarily involve the use of
medications but also include direct methods of brain
intervention, including electroconvulsive therapy (ECT),
transcranial magnetic stimulation (TMS), and psychosurgery.

➢ Types of Biological Therapies-

A. Drug therapies-
Drug therapies (psychopharmacotherapy), which rely on
medication for the treatment of mental disorders, are
sometimes used by professionals with appropriate medical or
pharmacological training in conjunction with psychotherapy.
Therapeutic drugs for psychological problems fall into four
major groups. Commonly used types of each and their generic
names, trade names (and chemical names) follow.
● Antianxiety drugs (mild tranquilizers) are used to relieve
anxiety.
 ■ benzodiazepines: Valium (diazepam), Xanax
(alprazolam), Librium (chlordiazepoxide)
■ barbiturates: Miltown (meprobamate)
■ hypnotics: Halcion (triazolam), Dalmane
(flurazepam)

When people discontinue these drugs after taking them for a

long time, they may suffer rebound anxiety (a reoccurrence of
the earlier anxiety).

● Antipsychotic drugs (also called major tranquilizers or

neuroleptics) are used primarily to treat schizophrenia and to
reduce psychotic symptoms such as hyperactivity,
hallucinations, delusions, and mental confusion.
■ phenothiazines: Mellaril (thioridazine), Thorazine
(chlorpromazine), Prolixin (fluphenazine)
■ butyrophenones: Haldol (haloperidol)

Pharmacotherapy treatment may produce side effects such as

drowsiness, constipation, and dry mouth. Antipsychotic drug
treatment may cause a severe and lasting problem called
tardive dyskinesia, a neurological disorder characterized by
involuntary writhing and ticlike movements of the mouth,
tongue, face, hands, or feet.
● Antidepressant drugs are used to elevate mood and to treat
depressions. Three principal classes of antidepressants are
■ tricyclics: Trofranil (imipramine), Elavil
(amitriptyline)
■ monoamine oxidase (MAO) inhibitors: Nardil
(phenelzine), Marplan (isocarboxazid)
■ selective serotonin reuptake inhibitors (SSRIs):
Zoloft (sertraline), Prozac (fluoxetine), Paxil
(paroxetine). Some patients taking Prozac have
developed suicidal tendencies.
● Anti-cycling agents, also called mood stabilizers, are drugs
such as Lithium (lithium carbonate) is used to treat patients
with bipolar mood disorders to control mood swings. The drug
may have dangerous side effects, however, such as kidney and
thyroid damage.

B. Electroconvulsive therapy (ECT)-

ECT is a treatment method that is sometimes used to treat
psychiatric disorders, such as major depression, that do not
respond to other forms of treatment (psychotherapy or
pharmacological treatments).
During treatment, a convulsion, or seizure, is induced by the
application of electrical current (about 0.6 amps) to the brain.
 It helps by shocking the brain and reducing the number of
neural connections involved in depression or other illnesses,
thereby stimulating the creation of new connections in other
areas of the brain. Some research suggests that ECT may
stimulate an increased production of neurotrophic growth
factors such as the brain derived neurotrophic factor (BDNF),
causing migration and proliferation of progenitor cells and
growth of new neurons in the hippocampus. The average
treatment requires 2–3 sessions a week. The total number of
treatments may vary, but generally between 6 and 12 total
treatments are recommended.

● History of Electroconvulsive Therapy-

Convulsive therapy was introduced in 1934 by Hungarian
neuropsychiatrist Ladislas J. Meduna, who is widely
considered to be the father of convulsive therapy. However,
Meduna used camphor, and later metrazol, rather than
electricity, to induce seizures. Italian professor of
neuropsychiatry Ugo Cerletti, who had been experimenting
with using electric shocks to produce seizures in animals,
developed the idea of using electricity as a substitute for
metrazol in convulsive therapy. In 1937, he and his colleagues
tested electroconvulsive therapy for the first time on a person.
Once they started trials on patients they found that after 10 to
20 treatments patients had improved greatly, though they
 experienced memory loss. This had benefits, however, as
patients could not remember the treatments and had no ill
feelings toward them. ECT soon replaced metrazol therapy all
over the world because it was cheaper, less frightening, and
more convenient.
● Efficacy of Electroconvulsive Therapy
ECT is a safe procedure with a mortality rate calculated to
approximately 0.2 per 100,000 treatments. It is currently used
in the treatment of major depressive disorder, mania,
schizophrenia, and catatonia. It has different levels of efficacy
depending on the disorder it is called on to treat.
Major Depressive Disorder
For major depressive disorder, ECT is generally used only
when other treatments have failed, or in emergencies, such as
imminent suicide. A meta-analysis done on the effectiveness of
ECT in unipolar and bipolar depression was conducted in
2012. Findings showed that, although patients with unipolar
depression and bipolar depression responded to other medical
treatments very differently, both groups responded equally well
to ECT. Overall remission rate for patients with unipolar
depression after a round of ECT treatment was 51.5%, and
50.9% in those with bipolar depression. When ECT was
followed by treatment with antidepressants, about 50% of
 people relapsed by 12 months following successful initial
treatment with ECT, with about 37% relapsing within the first
6 months. About twice as many relapsed with no
antidepressants.
Catatonia
ECT is generally a second-line treatment for people with
catatonia who don’t respond to other treatments, but is a
first-line treatment for severe or life-threatening catatonia.
There is a lack of clinical evidence for its efficacy but it has
been used successfully in the treatment of this disorder.
Mania
ECT is used to treat people who have severe or prolonged
mania; however, it is recommended only in life-threatening
situations or when other treatments have failed.
Schizophrenia
ECT is rarely used in treatment-resistant schizophrenia, but is
sometimes recommended for schizophrenia when short-term
global improvement is desired, or the subject shows little
response to antipsychotics alone.

C. Psychosurgery
It is a treatment in which brain tissue is destroyed with the aim
of alleviating the symptoms of a psychological disorder. It has
also been called “functional neurosurgery.” Psychosurgery is a
drastic step typically only taken in the absence of any other
successful treatment (and sometimes not even then), because it
is a major challenge to remove harmful tissue without
impacting the brain tissue necessary to retain full neural
function.
There are many types of psychosurgery. Many end in “-omy,”
the Latin root used in surgeries to indicate the removal of
something:-
Cingulotomy
Cingulotomy is a surgical procedure that severs the
supracallosal fibers of the cingulum bundle, which pass
through the anterior cingulate gyrus. This surgery is used to
treat obsessive-compulsive disorder (OCD) and depression.
Subcaudate Tractotomy
Subcaudate tractotomy is a surgery to sever the fibers
connecting the orbitofrontal cortex to the hypothalamus. It is
used primarily for depression and OCD.
Limbic Leucotomy
The limbic leucotomy combines the cingulotomy and
subcaudate tractotomy procedures. It was hypothesized that
making two lesions would produce better results, but the rate
of effectiveness is still approximately the same as the
subcaudate tractotomy procedure alone.
Corpus Callosotomy
 Corpus callosotomy is a palliative surgical procedure for the
treatment of seizures, as seen in epilepsy. Because the corpus
callosum is critical to the spread of epileptic activity between
brain hemispheres, the goal of this procedure is to eliminate
this pathway. The corpus callosum is severed, after which the
brain has much more difficulty sending messages between the
hemispheres, although some limited interhemispheric
communication is still possible.
Deep-Brain Stimulation

In deep-brain stimulation (DBS), a device like a pacemaker is

implanted into a part of the brain to send electrical impulses to
that area of the brain. It is used primarily for Parkinson’s
disease, essential tremor, and major depression, although it has
been used for a number of other disorders as well.

● History of Psychosurgery
This treatment approach began in the late 1800s under the
Swiss psychiatrist Gottlieb Burckhardt, and continued into the
mid 1930s under Portuguese neurologist Antonio Egas Moniz
with the leucotomy. A leucotomy is the cutting of white nerve
fibers in the brain, and is also known as a prefrontal lobotomy.
In the United States, neuropsychiatrist Walter Freeman and
neurosurgeon James W. Watts devised what became the
standard prefrontal procedure and named their operative
 technique “lobotomy.” In spite of Moniz’s Nobel Prize in 1949,
the use of psychosurgery declined during the 1950s. By the
1970s the standard lobotomy was very rare, but other forms of
psychosurgery were occurring on a smaller scale.

● Efficacy of Psychosurgery
Psychosurgery has a low rate of efficacy relative to the risks of
the procedures. For example, cingulotomies have been found
to be only about 30% percent effective. Subcaudate
tractotomies have been found to be effective about 50% of the
time, as have limbic leucotomy.

Advances in surgical techniques have greatly reduced the

incidence of death and serious damage from psychosurgery.
However, the risks include but are not limited to seizures,
incontinence, decreased drive, personality changes, cognitive
problems, and affective problems. Currently, interest in the
neurosurgical treatment of mental illness is shifting to
deep-brain stimulation (DBS), in which the aim is to stimulate
areas of the brain with implanted electrodes.

➢ Chemotherapy-
Chemotherapy is a form of medical treatment that uses
powerful chemicals, to treat life-threatening diseases like
cancer. Cancer cells usually grow and divide faster than normal
 cells. It usually works by keeping the cancer cells from
growing, dividing, and making more cells and creating a toxic
environment in the body that targets and kills the cancer cells
without doing permanent damage to the body itself. This type
of treatment is delivered intravenously (through the
bloodstream) or by pills and while highly effective frequently
has negative, but temporary, side-effects such as nausea, hair
loss and physical weakness.
Doctors use chemotherapy in different ways at different times.
These include:
● Before surgery or radiation therapy to shrink tumors. This
is called neoadjuvant chemotherapy.
● After surgery or radiation therapy to destroy any remaining
cancer cells. This is called adjuvant chemotherapy.
● As the only treatment. For example, to treat cancers of the
blood or lymphatic system, such as leukemia and
lymphoma.
● For cancer that comes back after treatment, called
recurrent cancer.
● For cancer that has spread to other parts of the body, called
metastatic cancer.

Chemotherapy may be given in several different ways, which

are discussed below:-
 ● Injection: The drugs are delivered with a shot directly into
muscle in the hip, thigh, or arm, or in the fatty part of arm, leg,
or stomach, just beneath the skin.
● Intra-arterial (IA): The drugs go directly into the artery that
is feeding the cancer, through a needle, or soft, thin tube
(catheter).
● Intraperitoneal (IP): The drugs are delivered to the peritoneal
cavity, which contains organs such as the liver, intestines,
stomach, and ovaries. It is done during surgery or through a
tube with a special port that is put in by the doctor.
● Intrathecal (IT) chemotherapy: Medicine is injected into the
cerebrospinal fluid (CSF), which is found in the area
surrounding the spinal cord and the brain.
● Intravenous (IV): The chemotherapy goes directly into a vein.
● Topical: Rubbing the drugs in a cream form onto the skin.
● Oral: Swallowing a pill or liquid that has the drugs.

The goals of chemotherapy depend on the type of cancer and how

far it has spread. Sometimes, the goal of treatment is to get rid of all
the cancer and keep it from coming back. If this is not possible, a
person might receive chemotherapy to delay or slow cancer growth.
Delaying or slowing cancer growth with chemotherapy also helps
manage symptoms caused by the cancer. Chemotherapy given with
the goal of delaying cancer growth is sometimes called palliative
chemotherapy

➔ References:-
● Kramer, G. P., Bernstein, D. A., & Phares, V. (2014).
Introduction to clinical psychology (8thEd.). Pearson.
● Boundless Psychology. (n.d.). Retrieved June 02, 2021,
from
https://courses.lumenlearning.com/boundless-psychology/
chapter/types-of-biomedical-therapy/

SUBMITTED BY-
PRAMJEET SINGH
190438