Clinical Psychology

Inc., the human resources consulting company he founded in 1969. In 1988, Selection Research, Inc. acquired Gallup, the public opinion polling organization. Clifton served as board chairman of Gallup from 1988 to 1999, leading the organization through an impressive period of growth.

Clifton led a group of Gallup researchers to innovative discoveries and applica- tions on many topics including employee selection, development, employee engagement, management and leadership. By studying top performers in the workplace, Clifton and his team of researchers developed hundreds of structured interviews to select high potential employees with talent suited for their role. The study of success across multiple roles also led to the development of the Clifton StrengthsFinder, Gallup’s online assessment that has helped millions of people around the world discover their talents and develop their strengths. Clifton and his research team also developed Gallup’s Q¹², an assessment designed to measure employee engagement through a simple set of actionable items. Gallup Univer- sity, one of the world’s leading providers of management and leadership educa- tion, applies Clifton’s theories to improve workplaces around the world.

A prolific author, Clifton’s thought leadership is captured in hundreds of scholarly articles, technical reports, and books. His 1992 book with Paula Nelson, Soar with Your Strengths, introduced the concept of strengths-based development.

Now, Discover Your Strengths: How to Develop Your Talents and Those of the People You Manage, written in 2001 with Marcus Buckingham, has been read by millions of managers and employees around the world. StrengthsQuest: Discover and Develop Your Strengths in Academics, Career, and Beyond, first released in 2002 with Edward

“Chip” Anderson, has taken the science of strengths development to hundreds of global college and university campuses. New York Times no. 1 Bestseller How Full is your Bucket? Positive Strategies for Work and Life, published in 2004 with grandson Tom Rath, draws on positive psychology research and outlines a simple metaphor of a dipper and a bucket to reveal how even the briefest interactions affect rela- tionships, productivity, health, and well-being. For his outstanding contributions to the science of positive psychology, in 2002 Clifton was cited as the Father of Strengths-Based Psychology and the Grandfather of Positive Psychology in an American Psychological Association Presidential Commendation.

SEE ALSO: Clifton StrengthsFinder Clifton Youth StrengthsExplorer

Employee engagement Gallup Strengths (Gallup)

Clinical Psychology

James E. Maddux

George Mason University

The Society of Clinical Psychology, a division of the American Psychological Association, offers this definition of clinical psychology on its website:

174 Clinical Psychology

The field of Clinical Psychology integrates science, theory, and practice to under- stand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development [and] focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socio- economic levels.

This definition and others emphasize the alleviation of “maladjustment, disability, and discomfort” but also mention the promotion of adjustment and personal development. For most of its history, however, clinical psychologists have been much more concerned with the former than with the latter. They have been much more concerned with abnormal and maladaptive psychological phenomena and processes – mental disorders, psychological disorders, or psychopathology– than with positive adjustment and positive well-being.

This focus on the pathological can be viewed as a kind of ideology – an illness ideology. Although the illness metaphor(also referred to as the medical model) pre- scribes a certain way of thinkingabout psychological problems (e.g., a psycholog- ical problem is likea biological disease), the illness ideologygoes beyond this and tells the clinical psychologist what to think about – to what aspects of human behav- ior the clinical psychologist should pay attention. Specifically, it dictates that the focus of attention should be disorder, dysfunction, and disease rather than health.

Thus, it narrows the focus on what is weak and defective about people to the exclu- sion of what is strong and healthy. It emphasizes abnormality over normality, poor adjustment over healthy adjustment and sickness over health. It promotes dichotomies between normal and abnormal behaviors, between clinical and non- clinical problems, and between clinical and nonclinical populations. It locates human adjustment and maladjustment inside the person rather than in the per- son’s interactions with the environment and encounters with social and cultural values and societal institutions. Finally, this ideology and its language portray people who seek help as passive victims of intra-psychic and biological forces beyond their direct control who must be the passive recipient of an expert’s care.

This illness ideology is embedded in the very name of the discipline. Clinical derives from the Greek klinike, meaning “medical practice at the sickbed,” and psychologyderives from psyche, meaning “soul” or “mind.” Evidence for this ideo- logy also can be found in the language used by the vast majority of clinical psy- chologists to describe their work and the people with whom they work. Terms such as symptom, disorder, pathology, illness, diagnosis, treatment, doctor, patient, clinic, clinical, andclinicianare all consistent with an ideology of illness and disease.

Clinical psychology was not steeped in the illness ideology at its beginning.

Some historians of psychology trace the beginning of the profession of clinical psychology in the United States back to the 1886 founding of the first psychological clinic in the United States at the University of Pennsylvania by Lightner Witmer.

Witmer and the other early clinical psychologists worked primarily with children who had learning or school problems – not with patients who had mental disorders.

Clinical Psychology 175 Thus, they were more influenced by psychometric theory and its emphasis on careful measurement than by psychoanalytic theory and its emphasis on psycho- pathology and illness, which was rapidly growing in popularity in Europe but had not, at that time, had much influence in North America. Following Freud’s 1909 visit to Clark University, however, psychoanalysis and its pathology-focused derivatives soon came to dominate both psychiatry and clinical psychology.

Psychoanalytic theory, with its emphasis on hidden intra-psychic processes and pathological sexual and aggressive urges, provided a fertile soil for the growth of the illness ideology.

Several other factors encouraged clinical psychologists to devote their attention to psychopathology and thereby strengthened the hold of the illness ideology over the field. First, although clinical psychologists were trained academically in universities, their practitioner training occurred primarily in psychiatric hospitals and clinics. In these settings, clinical psychologists worked primarily as psycho- diagnosticians under the direction of psychiatrists trained in medicine and psy- choanalysis. Second, after World War II, the United States Veterans Administration was founded and soon joined the American Psychological Association in develop- ing training centers for clinical psychologists. Because these training centers were in Veterans Administration hospitals, the training of clinical psychologists continued to occur primarily in psychiatric settings, which were steeped in both biological models and psychoanalytic models – approaches both concerned with illness and pathology. Third, the United States National Institute of Mental Health (NIMH) was founded in 1947. Despite its name, the NIMH was concerned prim- arily with mental illness, not mental health. As a result, large sums of money became available for the study of psychopathology and “thousands of psycholo- gists found out that they could make a living treating mental illness” (Seligman

& Csikszentmihalyi, 2000, p. 6). By the 1950s, the practice of clinical psychology in the United States was grounded firmly in four basic assumptions consistent with the illness ideology.

First, clinical psychology is concerned with psychopathology – deviant, abnormal, and maladaptive behavioral and emotional conditions. Thus, the focus is not be on facilitating mental health but on alleviating mental illness; not on the every- day problems in living experienced by millions, but on severe conditions experi- enced by a relatively small number of people.

Second, psychopathology, clinical problems, and clinical populations differ in kind, not just in degree, from normal problems in living, nonclinical problems, and nonclinical populations. Psychopathologies are distinct mental disorders, not merely extreme variants of common problems in living and expected human difficul- ties, flaws, and imperfections. For this reason, understanding psychopathology requires theories different from those theories that explain normal problems in living and effective psychological functioning.

Third, psychological disorders are distinct conditions or illnesses inside the individual that cause people to think feel, and behave maladaptively. The causes of emotional and behavioral problems are found inside the person rather than in

176 Clinical Psychology

the person’s interactions with his or her environment (including other people and society). Thus, to understand psychological problems, it is more important to understand and measure the fixed properties of people (e.g., personality traits) or their hidden intra-psychic conflicts than to understand and assess the complex interactions between the person and his or her life situations.

Fourth, the psychological clinician’s task is to identify (diagnose) the disorder (disease) inside the person (patient) and to prescribe an intervention (treatment) for eliminating (curing) the internal disorder (disease) responsible for the symp- toms. Even if the attempt to alleviate the problem is purely verbal, it is still referred to as treatment or therapy, unlike often equally successful attempts to educate or persuade on the part of teachers, ministers, friends, and family. In addition, these interactions between clinicians and their patients differ in kind from helpful and distress-reducing interactions between the patient and other people in his or her life and understanding them requires special theories.

The basic assumptions of the illness ideology continue as implicit guides to clinical psychologists’ activities, and they permeate the view of clinical psycho- logy held by the public and policy makers. In fact, the influence of the illness ideology probably has grown since the mid-20th century as a result of the grow- ing influence of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The influence of the first two editions (1952 and 1968) on research, practice, and clinical training was negligible, but this influ- ence increased greatly after the publication of the revised expanded 3rd edition in 1980. The DSM now provides the organizational structure for almost all textbooks and courses on abnormal psychology and psychopathology, as well as almost all books on the assessment and treatment of psychological problems for practicing clinical psychologists. The growth in the role of third-party funding for mental health services in the United States during this same period fueled the growth of the influence of the DSM as these third-parties began requiring a DSM diagnostic label as a condition for payment or reimbursement for mental health services.

Nowhere is the power of the illness ideology over clinical psychology in most of the developed world more evident than in the dominance of the DSM.