Clinical Psychology in the U.S.A.

Review of The Clinical Psychologist. By William A. Hunt, Ph.D. (Pp. 206+xii. 42s.) Springfield, Illinois: Charles C. Thomas. Oxford: Blackwell Scientific Publications. 1956.
Progress in Clinical Psychology. Volume II. Edited by Daniel Brower, Ph.D., and Lawrence E. Abt, Ph.D. (Pp. 364 +viii. $7.75.) New York and London: Grune and Stratton. 1956.

British Medical Journal, 6 July 1957, p. 32.

Though The Clinical Psychologist ostensibly deals with the training and functions of the clinica psychologist and the future of clinical psychology, a British reader will obtain very little information from it on these subjects. Psychiatric practice in America seems very different from that in this country, and the relations between psychiatrists and clinical psychologists are certainly radically different. Relations indeed seem so strained that the author has devoted most of his book to examining "the current tension between clinical psychology and medicine," saying how this tension has arisen and providing suggestions to remedy it. We are told that "in the early years of this century when psychiatry operated within an organic framework there was relatively little friction," but " as psychiatry has become the  primarily dynamically and developmentally oriented discipline it is to-day" friction has arisen because psychiatrists are operating "within a framework which has little to do with the physiological, organic orientation of medicine proper" but are "more and more . . . drawing upon the formal knowledge of psychology." This leads to what one would call, in trade-union terms, a demarcation dispute, or, as the author calls it, a boundary dispute; and he is reminded of the friction between medicine and dentistry over the boundaries of the alveolar process.

    The author thinks that a legitimate function of the clinical psychologist is psychotherapy, and he discusses the types of psychotherapy that he would regard as coming within his province, in both hospital and private practice. "Client-directed psychotherapy," for example, can be practised by the clinical psychologist. He thinks "it worth noting that the psychologist's incursion into the field of therapy with the ill has never extended to clearly medical techniques such as surgical [sic] and pharmaceutical interference," and that "insulin shock, metrazole, E.C.T., topectomy, lobotomy, etc.," are " techniques which the clinical psychologist is not prepared to handle." That the author should have felt the necessity to make these disclaimers indicates more clearly than any description the differences between British and American practice; and anyone who wants an insight into American psychiatry to-day will find this book fascinating.

    Progress in Clinical Psychology, Volume II, follows the pattern of Volume I published in 1952, and covers developments since then over a very wide field of projection tests, psychotherapy, special applications of clinical psychology to correctional institutions, rehabilitation of the physically handicapped, statistics, and neurophysiology of higher processes. Recent progress in these fields is covered very adequately, and the book comes up to the high standard of its predecessor and will be invaluable as a work of reference. A point of interest is that the authorship of this book underlines what has been said above about the functions of the clinical psychologist in America; of the twelve chapters dealing with progress in therapy, only three are by psychiatrists.