348 Clinical Psychology
During the 1970s, the APA was forced to become defini-
tive about what constituted a psychological training program.
This came about when graduates of guidance or counseling or
sundry other programs demanded to be certified or licensed
as psychologists and brought suit if their qualifications were
questioned. They asserted, unfortunately correctly, that the
courses that went into a psychology education were unspeci-
fied. Therefore, the APA made it known that as of 1980 all
graduate programs in psychology must require courses in the
history and systems of psychology; the biological, social,
developmental, and learned bases of behavior; and statistics
and research design. Moreover, clinical students were also
required to have instruction in psychological assessment and
intervention, individual differences and psychopathology,
practicum training, and a 1-year full-time internship.
So, what does all this suggest, aside from more regulation
and specification than anyone would have thought possible
or desirable a few years before? First, clinical psychologists
were increasing their numbers and becoming a dominant
force within American psychology and perhaps elsewhere as
well. They were evident in Canada, the United Kingdom, and
Scandinavia. Norway, for instance, was training about 100
psychologists a year at the doctoral level. These countries,
unlike the United States, had publicly supported health sys-
tems, which were major employers of clinical psychologists.
Although the United States has continued to emphasize a
rather lengthy, and somewhat indefinite, period of graduate
education leading to the doctorate for clinical psychologists, a
variety of other models exist elsewhere. In the United
Kingdom, a 3-year program leading to a doctor of clinical
psychology degree (D.Clin.Psy.) has emerged. In Germany,
Hungary, Mexico, and Spain, the PhD is usually reserved for
academicians and/or researchers; practitioners of clinical psy-
chology study in undergraduate-graduate programs lasting
up to 6 years, perhaps supplemented by postgraduate training
in psychoanalysis or behavior therapy (Donn, Routh, &
Lunt, 2000). Believing that it was about time that the largest
psychological field of specialization had its own international
organization, Routh (1998) and colleagues founded the Inter-
national Society of Clinical Psychology in 1998. This organi-
zation holds its meetings with various larger international
groups, such as the International Association of Applied Psy-
chology, the International Council of Psychologists, the Inter-
national Union of Psychological Science, or the European
Federation of Professional Psychology Associations. (See the
chapter by David & Buchanan in this volume for a full de-
scription of the international contacts in psychology.)
Second, with increasing numbers come divisions and
splits. When there are few psychologists, the interests of one
or two can be regarded as idiosyncrasies. When there are
thousands of psychologists, the interests of 1% or 2% may
constitute the beginning of a new field of specialization or a
new social grouping. APA membership has increased from
about 7,250 in 1950 to 16,644 in 1959 to 30,830 in 1970 to
50,933 in 1980 to about 150,000 in 2000. At one time, a
school psychologist was a clinical psychologist who worked
in a school setting, but eventually school psychology became
a field of specialization in its own right (Fagan, 1996, and the
chapter by Fagan in this volume). Similarly there are more
and more areas of specialization within clinical psychology
that could become separate fields, such as clinical neuropsy-
chology, clinical child psychology, and health psychology.
This differentiation is probably inevitable, but it is not with-
out the possible consequence of fostering less unity among
clinicians unless care is taken to ensure cohesiveness.
Third, there has been an increasing professionalization
within clinical psychology. Until World War II, very few
clinical psychologists were involved in private practice. The
role of the clinician changed from one of diagnosis and re-
search to diagnosis, treatment, and research. Correspond-
ingly, along the way from its inception in 1892, the APA’s
aim—“to advance psychology as a science”—has changed:
“to advance psychology as a science and as a means of pro-
moting human welfare” and “to advance psychology as a sci-
ence, as a profession, and as a means of promoting human
welfare.” As this is being written, the APA membership is
being polled on whether “health” should be inserted into the
aim of the association. Since many psychologists who ob-
jected to the growing professional interests of the APA left it
in 1989 to form a more exclusively scientific American Psy-
chological Society and since clinical psychologists constitute
more than half the APA membership, the professionalization
of the APA is not likely to be reversed. (See the chapter by
Benjamin, DeLeon, Freedheim, & VandenBos and the chap-
ter by Pickren & Fowler, both in this volume.) A concern
here is that clinicians not become divorced from their scien-
tific roots and function.
Treatment interventions can serve to illustrate much of
what we have discussed, and it is to that topic that we turn.TREATMENT INTERVENTIONSBy World War II, many of those who had broken with Freud
(such as, Adler, Jung, and Rank) established personality the-
ories, schools, and therapeutic systems of their own that were
unified by the importance they ascribed to unconscious moti-
vation in determining psychopathology. These “psychody-
namic” psychotherapies were augmented by those of Horney,
Sullivan, and Fromm, who, impressed by social forces and