352 Clinical Psychology
A second category of frequently used medications is anti-
depressants, including tricyclics (Tofranil) and selective
serotonin reuptake inhibitors (Prozac). These medications
have proven to be effective in many double-blind studies,
though not more so than cognitive behavior therapy or man-
ualized interpersonal psychotherapy, according to NIMH
clinical trials. Nevertheless, they have brought about a funda-
mental change in the practice of outpatient psychiatry, which
is much more involved with adjusting drug regimens and less
involved with psychotherapy than it used to be (Shorter,
1997). Lithium seems an effective treatment for manic states
and also has prophylactic value in managing bipolar disorder.
Again, while clinicians have made contributions to this area
(Jamison, 1992; Jamison & Akiskal, 1983), its administration
was a medical responsibility. The same thing can be said
about methylphenidate or Ritalin, the most frequently pre-
scribed drug for children, used in the treatment of attention
deficit hyperactivity disorder (ADHD). Clinical psycholo-
gists have been involved in evaluating the effects of stimu-
lant drugs (Conners, Sitarenios, Parker, & Epstein, 1998) and
in determining whether behavior therapy can be an effec-
tive treatment. Barkley (1990) used Ritalin to examine the
parent–child relations in children with ADHD. The parents of
these children tend to be overcontrolling but are less so when
their child is on Ritalin, thus indicating they are responsive
to their child’s level of hyperactivity. However, not all clini-
cal psychologists were content with restricting their role to
research with drugs.
During the 1980s, a movement began to permit clinical
psychologists with proper additional training to prescribe
these medications. The government sponsored a demonstra-
tion project to show its feasibility, and with that accom-
plished a few university training programs began to offer
courses that would prepare clinical psychologists to assume
that role. Although the majority of clinical psychologists
showed little interest in gaining prescription privileges
(Piotrowski & Lubin, 1989), that interest may be more
broadly kindled in the coming generations. An APA division
for psychologists who do have an interest in prescribing psy-
chotropic medications has been recently established. In 1995
APA Division 12, the Society of Clinical Psychology, set up
a task force to identify empirically supported psychological
interventions for various types of psychopathology. Such an
identification has decided implications for health service in-
surers, who can use it to determine if practitioners are entitled
to be reimbursed for their services. A listing of such treat-
ments tends to endorse behavior therapy approaches more so
than psychotherapy, which has led to understandable anguish
among psychotherapists, who believe their effects are not
fairly evaluated when overt symptoms are the major focus.
The criteria used for selecting empirically supported treat-
ments has been much discussed (Chambless & Hollon,
1998), and an interdiciplinary movement is under way, in-
cluding representatives of psychiatry, psychology, other men-
tal health fields, managed care executives, and consumers, to
develop treatment guidelines so that health care dollars can
be rationally allocated.CONCLUSIONS AND FUTURE TRENDSIt should be apparent that clinical psychology has come a long
way since 1896. Its growth was slow during the early years of
its development when it essentially focused on psychomet-
rics, research, and pedagogical services to children. Although
this was made clear in the chapter by Parke and Clarke-
Stewart in this volume, we should at least mention that the
major contribution of clinical psychologists at that time was
in the measurement of intelligence. The age scale of Binet-
Simon led to the revisions of Lewis Terman (the Stanford-
Binet), longitudinal studies of gifted children (Terman, 1925)
that are still being pursued, infant and adult scales that have
contributed to our understanding of intellectual functioning
throughout the life span, and fairly reliable and valid predic-
tors of success in school, work, and psychotherapy.
Following World War II, clinical psychology grew rapidly
until it became a dominant force in American psychology and
an established and legally recognized profession with a re-
spected place among the mental health disciplines. Its major
contribution in the postwar period has been in treatment for-
mulations, especially behavior therapy approaches.
Clinical psychology is now perhaps the most popular field
of psychological specialization in the world (Sexton &
Hogan, 1992). With increasing numbers of clinicians has
come a trend toward more and more areas of specialization
(e.g., school psychology, health psychology, clinical child
psychology, pediatric psychology, clinical geropsychology,
clinical neuropsychology, family psychology, psychological
hypnosis, rehabilitation psychology), many of which have
developed into fields of their own (Fagan, 1996; Wallston,
1997). In addition, the practices within the field have ex-
panded, with more sophisticated evaluation techniques (see
the chapter by Weiner in this volume), various therapeutic ap-
proaches (including use of the electronic medias), and the
possibility of prescribing psychotropic medications (see the
chapter by Benjamin, DeLeon, Freedheim, & VandenBos in
this volume).
Such growth in numbers and differentiation is to be ex-
pected. Nevertheless, care should be exercised to ensure that
psychologists are aware of their commonalties—their origins