Cover Page

Table of Contents

Title Page


Editorial Board

Handbook of Psychology Preface

Volume Preface



Part I: Psychopathology

Chapter 1: Diagnosis and Classification

Historical Background

Continuing Issues for ICD-11 and DSM-5



Chapter 2: Disorders of Childhood and Adolescence

Disorders of Childhood and Adolescence

The Significance of Children's Mental Health Problems

Understanding Disorders of Childhood and Adolescence

Child and Adolescent Disorders: An Overview

Externalizing Disorders: Attention-Deficit/Hyperactivity Disorder (ADHD)

Internalizing Disorders: Anxiety Disorders

Autism Spectrum Disorders

Current Issues and Future Directions

Implications for Treatment and Prevention


Chapter 3: Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder

Defining Characteristics

Alternative Diagnostic Conceptualizations


Comorbidity With Other Psychiatric Syndromes


Sociocultural Context

Biological Factors

An Integrated (Multidimensional) Etiological Concept


Chapter 4: Personality Disorders


The DSM-IV Personality Disorders

The Future of Personality Disorders

Summary and Conclusion


Chapter 5: Mood Disorders

Defining and Diagnosing Unipolar Depression

Course and Consequences of Unipolar Depression

Who Is Affected by Unipolar Depression?

Unipolar Depression: Theories of Etiology and Vulnerability

Psychological Models of Depression

Treatment of Depression

Bipolar Disorder

Conclusions and the Future


Chapter 6: Anxiety Disorders

Separation Anxiety Disorder

Obsessive-Compulsive Disorder

Specific Phobias

Social Phobia (Social Anxiety Disorder)

Panic Disorder With and Without Agoraphobia

Generalized Anxiety Disorder



Chapter 7: Sex and Gender Identity Disorders

Sexual Dysfunctions

Male Sexual Problems, Concerns, and Dysfunctions

Other Problems?


Gender Identity Disorders



Chapter 8: Disorders of Extreme Stress

Stress and Trauma

Acute Stress Disorder

Posttraumatic Stress Disorder

Complex PTSD

Dissociative and Conversion Disorders



Chapter 9: Disorders of Impulse Control



Substance Use Disorders and Pathological Gambling

Alcohol Use Disorders

Drug Use Disorders

Pathological Gambling

Concluding Comments


Chapter 10: Schizophrenia Spectrum Conditions

Current Schizophrenia Spectrum Conditions

A Brief History of the Concept of Schizophrenia

The Current Definition of Schizophrenia

Social Functioning

Factors Associated With Relapse

Behavioral Treatments



Part II: Psychotherapy

Chapter 11: Psychodynamic Psychotherapy

Psychodynamic Psychotherapy

Part I: The Psychodynamic Theory of Clinical Technique

Part II: The Evidence Base of Psychodynamic Theory and Practice

Automaticity: Background and Research

Clinical Implications of Automaticity

Summary and Conclusions

The Place of Psychoanalysis in Modern Psychology


Chapter 12: Behavior Therapy and Cognitive-Behavioral Therapy

Origins, Background, and Brief History

Clinical Research on Behavior Therapy and Cognitive-Behaviorial Therapy

Conclusions and Future Directions


Chapter 13: The Humanistic-Experiential Approach


Humanistic-Experiential Theory

The Practice of Humanistic-Experiential Psychotherapy

The Effectiveness of Humanistic Therapy

The Process of Change



Chapter 14: Psychotherapy Integration and Integrative Psychotherapies

Psychotherapy Integration: Definition and History

Factors That Have Promoted the Development of Psychotherapy Integration

The Modes of Psychotherapy Integration

New Developments in Psychotherapy Integration

Research on the Effectiveness of Psychotherapy Integration

The Range of Applicability of Integrative Psychotherapies

The Practice of Psychotherapy Integration

A Case Example



Chapter 15: Group Psychotherapies

Psychodynamic Approach

Cognitive Behavioral Approach

Interpersonal Therapy


Treatment Programs

Outpatient Psychotherapy

Partial Hospitalization

Inpatient Group Therapy

Effectiveness of Group Psychotherapies

Structural Features of Therapy Groups: Research and Practice



Chapter 16: Family Therapy


Defining Family Therapy

A Brief History of Family Therapy

Family Systems Theory

Prominent Models of Family Therapy

Experiential Approaches

Integrative Approaches

Efficacy of Family Therapy Approaches

Ethnicity and Culture




Chapter 17: Crisis Intervention

History and Theory of Crisis Intervention

Stress and Coping

Brief and Long-Term Psychotherapy Versus Crisis Intervention

Case Examples



Chapter 18: Brief Psychotherapies

Six Forms of Brief Therapy

Brief Psychodynamic Therapy

Cognitive-Behaviorial Therapy

Brief Couple and Family Therapy

Brief Experiential Therapy

Strategic Therapy

Brief Integrative-Eclectic Therapy


Chapter 19: Child Psychotherapy

Overview of Child Psychotherapy

Issues Related to the Conduct of Child and Adolescent Psychotherapy

Child and Adolescent Psychotherapy Models



Chapter 20: Psychotherapy With Older Adults Within a Family Context

CALTAP and the Older Client in Family Context

Sources of Disagreement and Dissatisfaction for Older Couples

Marital Interaction and Process

Retirement Transition

Caregiving Couples

Grief and the Formerly Coupled Survivor

CALTAP and the Coupled Older Adult

Parent–Child Dyads

CALTAP and Parent–Child Relationships

Family Systems Perspectives and the “Aging Family”

Implications for Practice



Chapter 21: Empirically Supported Treatments, Evidence-Based Treatments, and Evidence-Based Practice

From EBP to ESTs and EBTs, and Back Again: The Evolution of Evidenced-Based Practice

Can't We All Just Get Along?

Psychotherapy and Specific (Unique) Ingredients

EBTs and the Known Sources of Variance: The Common factors

Randomized Clinical Trials, Evidence-Based Treatments, and the Medical Model

Debunking Claims of Superiority: The Truth Is in the Tables

Empirically Supported Treatments, Evidence-Based Treatments, and Evidence-Based Practice: A Rose by Any Other Name?


Part III: Professional Issues

Chapter 22: Education, Training, Licensing, and Credentialing in Clinical Psychology


Doctoral Education

The Scientist-Practitioner Model

The Practitioner Model

Training for Practice: Practica, Internship, and Postdoctoral Residencies

Professional Licensure

Certification Beyond Licensure



Chapter 23: Ethical Practice in Clinical Psychology

Ethical Practice in Clinical Psychology

A Focus on Ethics

Ethical Decision Making

The APA Ethics Code

The Regulatory Environment

Resolving Ethical Conflicts With the Regulatory Environment


Informed Consent and Assent


Fees and Financial Arrangements

Boundaries and Multiple Relationships

Advertising and Public Statements

Record Keeping

Education and Training

Research and Publication



Conclusions and Recommendations


Chapter 24: The U.S. Health-Care Marketplace: Future Tense

Stakeholders and Their Strategies

Evolution of Health Care in the United States

Implications for the Future



Chapter 25: Evolving Roles for the Profession

The Political Context for Health-Care Reform

Does Psychology Training Prepare for an Expanded Health-Care Role?

Opportunities in Primary Care

Public Health and Wellness

From the Front Line of Prescriptive Authority (RxP)

An Exciting Policy Opportunity for the Next Generation

Are We Evolving Fast Enough?

Final Thoughts


Author Index

Subject Index

Title Page

Editorial Board

Volume 1
History of Psychology
Donald K. Freedheim, PhD
Case Western Reserve University
Cleveland, Ohio
Volume 2
Research Methods in Psychology
John A. Schinka, PhD
University of South Florida
Tampa, Florida
Wayne F. Velicer, PhD
University of Rhode Island
Kingston, Rhode Island
Volume 3
Behavioral Neuroscience
Randy J. Nelson, PhD
Ohio State University
Columbus, Ohio
Sheri J. Y. Mizumori, PhD
University of Washington
Seattle, Washington
Volume 4
Experimental Psychology
Alice F. Healy, PhD
University of Colorado
Boulder, Colorado
Robert W. Proctor, PhD
Purdue University
West Lafayette, Indiana
Volume 5
Personality and Social Psychology
Howard Tennen, PhD
University of Connecticut Health Center
Farmington, Connecticut
Jerry Suls, PhD
University of Iowa
Iowa City, Iowa
Volume 6
Developmental Psychology
Richard M. Lerner, PhD
M. Ann Easterbrooks, PhD
Jayanthi Mistry, PhD
Tufts University
Medford, Massachusetts
Volume 7
Educational Psychology
William M. Reynolds, PhD
Humboldt State University
Arcata, California
Gloria E. Miller, PhD
University of Denver
Denver, Colorado
Volume 8
Clinical Psychology
George Stricker, PhD
Argosy University DC
Arlington, Virginia
Thomas A. Widiger, PhD
University of Kentucky
Lexington, Kentucky
Volume 9
Health Psychology
Arthur M. Nezu, PhD
Christine Maguth Nezu, PhD
Pamela A. Geller, PhD
Drexel University
Philadelphia, Pennsylvania
Volume 10
Assessment Psychology
John R. Graham, PhD
Kent State University
Kent, Ohio
Jack A. Naglieri, PhD
University of Virginia
Charlottesville, Virginia
Volume 11
Forensic Psychology
Randy K. Otto, PhD
University of South Florida
Tampa, Florida
Volume 12
Industrial and Organizational Psychology
Neal W. Schmitt, PhD
Michigan State University
East Lansing, Michigan
Scott Highhouse, PhD
Bowling Green State University
Bowling Green, Ohio

Handbook of Psychology Preface

The first edition of the 12-volume Handbook of Psychology was published in 2003 to provide a comprehensive overview of the current status and anticipated future directions of basic and applied psychology and to serve as a reference source and textbook for the ensuing decade. With 10 years having elapsed, and psychological knowledge and applications continuing to expand, the time has come for this second edition to appear. In addition to well-referenced updating of the first edition content, this second edition of the Handbook reflects the fresh perspectives of some new volume editors, chapter authors, and subject areas. However, the conceptualization and organization of the Handbook, as stated next, remain the same.

Psychologists commonly regard their discipline as the science of behavior, and the pursuits of behavioral scientists range from the natural sciences to the social sciences and embrace a wide variety of objects of investigation. Some psychologists have more in common with biologists than with most other psychologists, and some have more in common with sociologists than with most of their psychological colleagues. Some psychologists are interested primarily in the behavior of animals, some in the behavior of people, and others in the behavior of organizations. These and other dimensions of difference among psychological scientists are matched by equal if not greater heterogeneity among psychological practitioners, who apply a vast array of methods in many different settings to achieve highly varied purposes. This 12-volume Handbook of Psychology captures the breadth and diversity of psychology and encompasses interests and concerns shared by psychologists in all branches of the field. To this end, leading national and international scholars and practitioners have collaborated to produce 301 authoritative and detailed chapters covering all fundamental facets of the discipline.

Two unifying threads run through the science of behavior. The first is a common history rooted in conceptual and empirical approaches to understanding the nature of behavior. The specific histories of all specialty areas in psychology trace their origins to the formulations of the classical philosophers and the early experimentalists, and appreciation for the historical evolution of psychology in all of its variations transcends identifying oneself as a particular kind of psychologist. Accordingly, Volume 1 in the Handbook, again edited by Donald Freedheim, is devoted to the History of Psychology as it emerged in many areas of scientific study and applied technology.

A second unifying thread in psychology is a commitment to the development and utilization of research methods suitable for collecting and analyzing behavioral data. With attention both to specific procedures and to their application in particular settings, Volume 2, again edited by John Schinka and Wayne Velicer, addresses Research Methods in Psychology.

Volumes 3 through 7 of the Handbook present the substantive content of psychological knowledge in five areas of study. Volume 3, which addressed Biological Psychology in the first edition, has in light of developments in the field been retitled in the second edition to cover Behavioral Neuroscience. Randy Nelson continues as editor of this volume and is joined by Sheri Mizumori as a new co-editor. Volume 4 concerns Experimental Psychology and is again edited by Alice Healy and Robert Proctor. Volume 5 on Personality and Social Psychology has been reorganized by two new co-editors, Howard Tennen and Jerry Suls. Volume 6 on Developmental Psychology is again edited by Richard Lerner, Ann Easterbrooks, and Jayanthi Mistry. William Reynolds and Gloria Miller continue as co-editors of Volume 7 on Educational Psychology.

Volumes 8 through 12 address the application of psychological knowledge in five broad areas of professional practice. Thomas Widiger and George Stricker continue as co-editors of Volume 8 on Clinical Psychology. Volume 9 on Health Psychology is again co-edited by Arthur Nezu, Christine Nezu, and Pamela Geller. Continuing to co-edit Volume 10 on Assessment Psychology are John Graham and Jack Naglieri. Randy Otto joins the Editorial Board as the new editor of Volume 11 on Forensic Psychology. Also joining the Editorial Board are two new co-editors, Neal Schmitt and Scott Highhouse, who have reorganized Volume 12 on Industrial and Organizational Psychology.

The Handbook of Psychology was prepared to educate and inform readers about the present state of psychological knowledge and about anticipated advances in behavioral science research and practice. To this end, the Handbook volumes address the needs and interests of three groups. First, for graduate students in behavioral science, the volumes provide advanced instruction in the basic concepts and methods that define the fields they cover, together with a review of current knowledge, core literature, and likely future directions. Second, in addition to serving as graduate textbooks, the volumes offer professional psychologists an opportunity to read and contemplate the views of distinguished colleagues concerning the central thrusts of research and the leading edges of practice in their respective fields. Third, for psychologists seeking to become conversant with fields outside their own specialty and for persons outside of psychology seeking information about psychological matters, the Handbook volumes serve as a reference source for expanding their knowledge and directing them to additional sources in the literature.

The preparation of this Handbook was made possible by the diligence and scholarly sophistication of 24 volume editors and co-editors who constituted the Editorial Board. As Editor-in-Chief, I want to thank each of these colleagues for the pleasure of their collaboration in this project. I compliment them for having recruited an outstanding cast of contributors to their volumes and then working closely with these authors to achieve chapters that will stand each in their own right as valuable contributions to the literature. Finally, I would like to thank Brittany White for her exemplary work as my administrator for our manuscript management system, and the editorial staff of John Wiley & Sons for encouraging and helping bring to fruition this second edition of the Handbook, particularly Patricia Rossi, Executive Editor, and Kara Borbely, Editorial Program Coordinator.

Irving B. Weiner
Tampa, Florida

Volume Preface

This eighth volume of the Handbook of Psychology is devoted to the primary concerns of clinical psychologists with understanding mental, emotional, and behavioral disorders; with developing and applying psychological techniques for alleviating these disorders; and with issues of importance to the profession of clinical psychology. We provide in this second edition of our volume an updated presentation of what is currently known about the origins, characteristics, and treatment of psychopathology, as well as likely future advances in this knowledge. The first 10 chapters address the diagnosis, etiology, course, and pathology of the major psychological disorders; the next 11 chapters describe psychotherapeutic approaches commonly used in treating these disorders; and the concluding four chapters discuss several key professional issues in clinical psychology. It should be noted that there are no chapters dealing with assessment, which is a core component of clinical psychology, because psychological assessment is covered extensively in Volume 10 of the Handbook (Assessment Psychology). Similarly, each of the chapters in the present volume incorporates attention to research and historical developments, but there is no separate chapter on clinical research methods, which are discussed in Volume 2 of the Handbook (Research Methods in Psychology), or on the history of clinical psychology, which is reviewed in Volume 1 (History of Psychology).

The first chapter, by Thomas A. Widiger and Cristina Crego, is devoted to the classification and diagnosis of psychopathology. As they indicate, a common language for describing the problems of the mind is necessary in clinical research and practice. The predominant taxonomy of psychopathology is provided by the American Psychiatric Association's (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). There is much to applaud with respect to the value, utility, and validity of this diagnostic manual, but there is also much that is potentially quite problematic. An updated version of this chapter is particularly timely given that the American Psychiatric Association is currently revising its manual (to become DSM-5). The process and content of this effort has been relatively controversial.

Eric J. Mash and David A. Wolfe follow with an updated version of their chapter on the major domains of child psychopathology. Beginning with disorders of childhood is an obvious starting point for understanding the development of psychopathology. However, as indicated by Mash and Wolfe, current knowledge of disorders of childhood and adolescence are hindered by a lack of child-specific developmental theories, and the inherent conceptual and research complexities associated with studying children, which may explain why there are fewer evidence based treatments for children than for adults. Despite these caveats, tremendous advances have been made over the last decade. New conceptual frameworks and research methods have greatly enhanced our understanding of childhood disorders, as well as our ability to help children with these problems. Also noteworthy has been an increase in interdisciplinary research and integration of science into clinical practice. All of these advances are articulated within this updated version.

Eating disorders were classified as a disorder of childhood and adolescence in earlier diagnostic nomenclatures, but it is now recognized that they can have an onset into adulthood. Eating disorders have been recognized since the beginning of medicine and are among the more frequently diagnosed and treated mental disorders. Howard Steiger, Kenneth R. Bruce, and Mimi Bruce update their chapter on eating disorders. They had included not only anorexia nervosa and bulimia within the original version of this chapter, but also binge eating disorder, which appears likely to be approved for inclusion within DSM-5. They provide in their chapter a compelling integrative conceptualization that considers developmental, cognitive, social, dynamic, and neurophysiological contributions to the etiology and pathology of eating disorders.

Personality disorders were placed on a separate, distinct axis for diagnosis in the third edition of the DSM-IV-TR (American Psychiatric Association, 2000) in recognition of their prevalence and their contribution to the course and treatment of other mental disorders. Timothy J. Trull, Ryan J. Carpenter, and Thomas A. Widiger cover in their chapter not only what is largely known and understood regarding disorders of personality but also the controversies that bedevil this section of the diagnostic manual. An updated version of this chapter is very timely given the major changes that have been proposed and are likely to occur with DSM-5, including the deletion of up to half of the diagnoses and a shift toward a dimensional model of classification that they had recommended in the first edition of this book.

Mood and anxiety disorders are the most frequent mental disorders and are probably the most frequently treated by clinical psychologists. As suggested by Constance Hammen and Danielle Keenan-Miller, depressive disorders are so ubiquitous that they have been called the common cold of psychological disorders. However, Hammen documents well in her thoroughly updated chapter that prevalence does not imply simplicity, and she again emphasizes the importance of considering etiology and pathology from divergent perspectives, including the cognitive, interpersonal, developmental, and neurobiological.

Kaitlin P. Gallo, Johanna Thompson-Hollands, Donna B. Pincus, and David H. Barlow provide a comparably sophisticated overview of the etiology, development, and pathology of the many variations of anxiety disorder. They review in particular separation anxiety disorder, obsessive-compulsive disorder, specific phobias, panic disorder with and without agoraphobia, and generalized anxiety disorder, indicating what is unique to each of them but emphasizing as well the importance of recognizing what may in fact be common to them all. These authors provide a very thorough life span developmental understanding, again representing well divergent perspectives within an integrative conceptualization.

Regrettably, the prior edition of this text did not include a chapter on sex and gender identity disorders. This gap in coverage is filled very well by the next chapter provided by Peggy J. Kleinplatz and Charles Moser, covering sexual dysfunctions, paraphilias, and gender identity issues. They consider psychological, interpersonal, psychosocial, and medical contributions to the etiology and pathology of sexual dysfunctions. They cover ongoing controversies surrounding the paraphilias, such as the need to distinguish between normophilic and paraphilic interactions. They consider a number of controversies surrounding DSM-5, such as the emergence of a transgender community's reaction to diagnostic labeling.

The next two chapters separated themselves somewhat from DSM-IV-TR, but in the end appear to have been quite prescient. Etzel Cardena, Lisa D. Butler, Sophie Reijman, and David Spiegel again call for a section of the manual devoted to disorders of extreme stress that would include conditions currently classified in different sections of the diagnostic manual. This proposal received formal approval for consideration in DSM-5. In the end, it might not be approved at all (and is unlikely to be approved in a manner entirely consistent with the suggestions of Cardena and colleagues), but it is evident that these authors are on the cutting edge of this area of psychopathology. There is perhaps much to appreciate and understand through the integrative conceptualization of the dissociative, posttraumatic stress, acute stress, and conversion disorders within one common section of the diagnostic manual.

In an analogous albeit different theoretical perspective, Kenneth J. Sher, Rachel Winograd, and Angela Haeny provide an integrative review of disorders of impulse dyscontrol. They covered within the prior version of this chapter pathological gambling as well as alcohol and drug usage. Their updated version of this chapter is again quite timely, as a formal proposal for DSM-5 is to shift substance use disorders and pathological gambling into a new section of the diagnostic manual for behavior addictions. Sher and colleagues provide again the empirical and conceptual support for this major revision to the diagnosis and conceptualization of substance use disorders and pathological gambling.

The final chapter by Philip D. Harvey and Christopher R. Bowie covers a variety of disorders included within a common spectrum of schizophrenia-related dysfunction. For example, one of the major proposals for DSM-5 is to shift schizotypal personality disorder out of the personality disorders and into a new section of schizophrenia-spectrum disorders that Harvey and Bowie eloquently conceptualize. They also indicate how pharmacological interventions have met with limited success, whereas cognitive remediation interventions have made considerable strides in the past decade. Like many other domains of research and treatment, advances in mapping the human genome and understanding the complexities of inheritance of behavioral traits have improved the understanding of schizophrenia. The future of research and treatment in schizophrenia spectrum conditions will likely include advances in understanding the neuroscience of social behavior and social cognition, as well as developing combination therapies employing psychosocial/behavioral interventions and pharmacotherapy.

Following the description of the range of psychopathology in Part I, the volume then moves into an account of the treatment of those disorders in Part II, which begins with three chapters that describe the major orientations toward psychotherapy—psychodynamic, cognitive-behavioral, and humanistic—and adds an account of an exciting new development that transcends single schools: psychotherapy integration.

The first chapter in Part II covers the oldest of the single schools of psychotherapy, psychodynamic psychotherapy, and it is described thoroughly and well by Larry Josephs and Joel Weinberger. Psychodynamic psychotherapy is not limited to the work of Freud; and although the contributions of the founder are described thoroughly, so are more recent developments in British object relations and American interpersonal theories, the self psychology movement, and contemporary intersubjective and relational theories. The research that supports much of this work also is described.

The primary single school alternative to psychodynamic psychotherapy is behavioral and cognitive-behavioral psychotherapy, and this is presented thoroughly and well by W. Edward Craighead, Linda Craighead, Lorie Ritschel, and Alexandra Zagoloff. This, too, is not a simple and unitary approach, but combines both behavior therapy and cognitive-behavioral psychotherapy, each of which has many variations. The clinical approach is integrated in the presentation with extensive research evidence, and the description of specific treatments for specific syndromes can be read in conjunction with many of the chapters in Part I that describe these syndromes in more detail. Along with psychodynamic psychotherapy and behavioral and cognitive-behavioral psychotherapy, there always has been a third force, the humanistic-experiential school. This is covered by Leslie Greenberg, Robert Elliott, Germain Lietaer, and Jeanne Watson and it also incorporates many individual approaches within the generic orientation, such as person-centered, Gestalt, existential, and experiential therapy. They all share a commitment to a phenomenological approach, a belief in the uniquely human capacity for reflective consciousness and growth, and a positive view of human functioning. Here, as in all the psychotherapy chapters, research evidence also is covered.

The fourth chapter that deals with individual psychotherapy does not recognize the boundaries established by schools, which themselves, as we have seen, are more heterogeneous than is commonly believed. Rather, psychotherapy integration seeks to take from each that which is most useful, and these attempts are described by Jerry Gold and George Stricker. Just as the single schools are more complex than initially appears to be the case, psychotherapy integration is made up of many different attempts at rapprochement, drawing freely from all other theoretical and technical approaches and from research evidence. It is interesting to note that many of the leading practitioners of individual schools, including most of the authors of the chapters presenting those schools, are involved in attempts at a higher order integration of their work, which should work for the benefit of the patients that are served.

Aside from the individual approaches to psychotherapy, two other modalities are quite prominent. Patients are seen not only as individuals but also in groups or along with other members of their family. Group psychotherapy is described by William Piper and Carlos Sierra. The goals of group therapy vary from overall personality reorganization to symptom-focused work and deal with patients in outpatient and inpatient settings. There also is a gamut of theoretical approaches that parallel the approaches that have been described in the chapters covering individual orientations to psychotherapy.

Family therapy is covered by Jay Lebow and Catherine Stroud. Although an understanding of family systems theory is necessary for this work, the variations in application are every bit as great as in individual and group psychotherapy, if not greater. Many approaches to family therapy are becoming integrative, consistent with the reports of an earlier chapter. Alongside the typical approaches to psychotherapy, specific attention is given to culturally competent family therapy and gender-sensitive approaches to family therapy.

Two very popular approaches that represent applications of psychotherapy in specific situations or formats are crisis intervention therapy and brief psychotherapy. Crisis intervention is the focus of the chapter by Lisa M. Brown, Kathryn Frahm, and Bruce Bongar. Crisis intervention involves the provision of emergency mental health care to individuals and groups. Crises can refer to unusual and devastating events or to milestones in human life. Examples are given concerning care to suicidal patients, survivors of disaster, and patients and families struggling with debilitating illness. The immediate response to these crises can be of great help to the victim and also can provide the opportunity for much human growth. Cultural considerations, current research, and issues in working with mental health teams are reviewed, along with the many theoretical approaches that are taken to resolving crises.

The brief psychotherapies are presented by Stanley B. Messer, William C. Sanderson, and Alan S. Gurman. Brief versions of each of the major orientations, including psychotherapy integration, are described, and a brief approach to marital and family psychotherapy is also covered. It may be a reflection of the current health-care scene that there is more attention given to working in a more abbreviated fashion, but this is not necessarily second best, and the chapter makes clear how much good work can be done in a shorter time frame than is customarily considered.

Up to this point every chapter has focused on the adult population. However, in a life span framework, the other ends of the chronological spectrum also must be considered. Child psychotherapy is described by Richard J. Morris, Kristin Thompson, and Yvonne P. Morris. Although the title is narrow, the conception includes adolescents as well as children, and the approaches cover the usual spectrum ranging from psychodynamic to cognitive-behavioral to humanistic approaches. Given the formative importance of early experience, the treatment of younger people is an important contribution to the mental health of the population, and this chapter covers the various indications and approaches.

At the other end of the age spectrum, the approaches to treating the older patient are presented by Bob G. Knight and Jennifer Kellough. They adopt an integrative model, drawing on the usual approaches to individual treatment and adopting methods, where necessary, to the needs of the older adult. The chapter uses Knight's Contextual Adult Life Span Theory for Adapting Psychotherapy to guide the consideration of ways in which the treatment of older adults differs from treatment of younger adults.

Finally, Part II concludes with a chapter on Evidence-based practice by Barry Duncan and Robert J. Reese. This is an area of enormous current interest, and the authors cover a controversial area by giving attention to all of the requirements involved for true evidence-based practice to take place. A critical distinction between evidence-based practice and empirically supported techniques is made.

In each of the chapters in Part II, concerned as they all are with psychotherapy, the picture arises of a field marked by great heterogeneity. The value of integration is presented, either in a specific chapter devoted to psychotherapy integration or as incorporated in many other chapters that deal with specific populations or modalities. Each chapter presents evidence for the approach being presented, and the picture of an evolving and developing field, marked by great promise and great accomplishment, is clear.

Clinical psychology is a science and a practice, and both elements have been presented consistently throughout the first two parts. It also is a profession, and issues that concern the profession are the topic of Part III. It is not sufficient for an individual to declare himself to be a clinical psychologist; rather, much training is required, and credentials are necessary so that members of the public who wish to use the service of professional psychologists can be well-informed and well-served. Concerns about the education, training, licensing, and credentialing of clinical psychologists are presented by Judy E. Hall and Elizabeth M. Altmaier. They cover these issues as manifested in the United States, Canada, and also in Latin America and the European Union. They also address the recent emphasis on mobility and the comparability of training and credentials in a context of accountability.

A profession must be self-regulating and serve the interests of the public if it is to be established and accepted. One necessary component of self-regulation is ethical practice, and issues about ethics that relate to clinical psychology are described by Jeffrey Barnett and Stephen Behnke. The APA ethics code is generic and applies to all psychologists, but this chapter focuses on those issues that are of most concern to the clinical psychologist. These include major ethical practice issues and frequent problems experienced by practitioners. Familiarity with these issues and their successful resolution are necessary for the sound practitioner, and this presentation should help to focus the potential problem areas and the models of understanding and resolving them.

Clinical psychology is practiced in a social context, and the changing context has had a marked effect on the nature of the practice. The health-care marketplace in the United States is described by David J. Drum and Andrew Sekel. Their survey is both historical and conceptual, and it traces the evolution of health care in the United States from its early stage of self-regulation and independence to the current stage of input from multiple stakeholders in health-care delivery. The implication this has for the future is not clear, of course, but some very educated guesses are offered, as well as the identification of key areas of concern.

Finally, we turn our attention to the future. Patrick H. DeLeon, Morgan Sammons, Sandra Wilkniss, Kristofer Hagglund, Stephen Ragusea, and Anthony Ragusea explore areas of expanding roles for psychologists in future years. They discuss the impact of the new health-care legislation and other cutting-edge areas such as primary care practice, telehealth, public health, and prescriptive authority and policy opportunities. As our society evolves, the field of clinical psychology also must evolve, and these authors lay out many possibilities for growth and development.

Clinical psychology is an expanding science and profession, and its capacity to continue to be relevant depends on its ability to adapt to changing social conditions, needs, and opportunities. We began with an account of historical factors, attempted to provide a context for the current state of the field, presented chapters that described these developments in detail, and concluded with a look toward the future. Clinical psychology has made major contributions to the discipline of psychology and to the welfare of society, and it shows every indication of continuing to grow and evolve with the world about it, and, by doing so, to retain its position at the forefront of scientific and professional developments. We hope that we have been successful in outlining these possibilities and that we will be witness to continued growth and development.

George Stricker
Thomas A. Widiger


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Benjamin, L. T. (1996). Lightner Witmer's legacy to American psychology. American Psychologist, 51, 235–236.

Hilgard, E. R. (1987). Psychology in America: A historical survey. New York, NY: Harcourt Brace Jovanovich.

Murray, H. A. (1956). Morton Prince. Journal of Abnormal Psychology, 52, 291–295.

Witmer, L. (1907). Clinical psychology. The Psychological Clinic, 1, 1–9.


Elizabeth M. Altmaier, PhD
Department of Psychological and Quantitative Foundations
University of Iowa
Iowa City, IA
David H. Barlow, PhD, ABPP
Department of Psychology
Boston University
Boston, MA
Jeffrey E. Barnett, PsyD, ABPP
Department of Psychology
Loyola University Maryland
Baltimore, MD
Stephen H. Behnke, JD, PhD
American Psychological Association Ethics Office
750 First Street, NE
Washington, DC 20002
Bruce Bongar, PhD, ABPP
Palo Alto University
Palo Alto, CA
Department of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Stanford, CA
Christopher R. Bowie, PhD
Departments of Psychology and Psychiatry
Queen's University
Kingston, Ontario, Canada
Lisa M. Brown, PhD
School of Aging Studies
College of Behavioral and Community Sciences
University of South Florida
Tampa, FL
Kenneth R. Bruce, PhD
Eating Disorders Program
Douglas Hospital
Department of Psychiatry
McGill University
Montreal, Quebec, Canada
Lisa D. Butler, PhD
School of Social Work
State University of New York
Buffalo, NY
Etzel Cardena, PhD
Department of Psychology
Lund University
Lund, Sweden
Ryan J. Carpenter, BA
Department of Psychological Science
University of Missouri
Columbia, MO
Linda W. Craighead, PhD
Department of Psychology
Emory University
Atlanta, GA
W. Edward Craighead, PhD
Department of Psychiatry and Behavioral Sciences
Department of Psychology
Emory University
Atlanta, GA
Cristina Crego, BA
Department of Psychology
University of Kentucky
Lexington, KY
Patrick H. DeLeon, PhD
Former APA President
David J Drum, PhD, ABPP
Department of Educational Psychology
University of Texas
Austin, TX 78712
Barry Duncan, PsyD
The Heart and Soul of Change Project
Jensen Beach, FL
Robert Elliott, PhD
School of Psychological Sciences and Health
University of Strathclyde
Glasgow, Scotland
Kathryn A. Frahm, PhD
School of Aging Studies
University of South Florida
Tampa, FL
Kaitlin P. Gallo, MA
Department of Psychology
Boston University
Boston, MA
Jerry Gold, PhD, ABPP
Derner Institute of Advanced Psychological Studies
Adelphi University
Garden City, NY
Leslie S. Greenberg PhD
Department of Psychology
York University
4700 Keele St.
Toronto, ON, Canada
Alan S. Gurman, PhD
The Family Institute at Northwestern University
Evanston, IL
Clinical Psychology Doctoral Program
University of Wisconsin
Madison, WI
Angela Haeny, MA
Department of Psychological Science
University of Missouri
Columbia, MO
Kristofer J. Hagglund, PhD
School of Health Professions and MPH Program
University of Missouri
Columbia, MO
Judy E. Hall, PhD
Executive Officer
National Register of Health Service Providers in Psychology
Washington, DC
Constance Hammen, PhD
Department of Psychology
University of California
Los Angeles, CA
Philip D. Harvey, PhD
Department of Psychiatry and Behavioral Sciences
University of Miami Miller School of Medicine
Miami, FL
Mimi Israel, MD
Eating Disorders Program
Douglas Hospital
Department of Psychiatry
McGill University
Montreal, Quebec, Canada
Lawrence Josephs, PhD
Derner Institute of Advanced Psychological Studies
Adelphi University
Garden City, NY
Danielle Keenan-Miller, PhD
Department of Psychology
University of Southern California
Los Angeles, CA
Jennifer L. Kellough, MA
Department of Psychology
University of Southern California
Los Angeles, CA
Peggy J. Kleinplatz, PhD
Department of Psychiatry
University of Ottawa
Ottawa, Ontario, Canada
Bob G. Knight, PhD
Davis School of Gerontology and Department of Psychology
University of Southern California
Los Angeles, CA
Jay L. Lebow, PhD, ABPP
Family Institute at Northwestern University
Evanston IL
Arlene Istar Lev, LCSW-R, CASAC
School of Social Welfare
University at Albany
Albany, NY
Germain Lietaer, PhD
Department of Clinical Psychology
Catholic University Leuven
Leuven, Belgium
Eric J. Mash, PhD
Department of Psychology
University of Calgary
Calgary, Alberta, Canada
Stanley B. Messer, PhD
Graduate School of Applied and Professional Psychology
Rutgers University
Piscataway, NJ
Richard J. Morris, PhD
School Psychology Program
University of Arizona
College of Education
Tucson, AZ
Yvonne P. Morris, PhD
Private Practice
Tucson, AZ
Charles Moser, MD, PhD
Department of Sexual Medicine
Institute for Advanced Study of Human Sexuality
San Francisco, CA
Donna B. Pincus, PhD
Department of Psychology
Boston University
Boston, MA
William E. Piper, PhD
Department of Psychiatry
The University of British Columbia
Vancouver, BC
Anthony S. Ragusea, PsyD
Private Practice
Key West, FL
Stephen A. Ragusea, PsyD
Private Practice
Key West, FL
Robert J. Reese, PhD
Department of Educational, School, & Counseling Psychology
University of Kentucky
Lexington, KY
Sophie Reijman, BSc
Child and Family Studies
Leiden University
Leiden, The Netherlands
Lorie A. Ritschel, PhD
Department of Psychiatry and Behavioral Sciences
Emory University School of Medicine
Atlanta, GA
Morgan T. Sammons, PhD, ABPP
California School of Professional Psychology
San Francisco, CA
William C. Sanderson, PhD
Department of Psychology
Hofstra University
Hempstead, NY 11549
Andrew Sekel, PhD
Chief Executive Officer
OptumHealth Behavioral Solutions
San Francisco, CA
Kenneth J. Sher, PhD
Department of Psychological Science
University of Missouri
Columbia, MO
Carlos A. Sierra Hernandez, BA
Department of Psychiatry
The University of British Columbia
Vancouver, BC
David Spiegel, MD
Department of Psychiatry and Behavioral Sciences
Stanford University
Stanford, CA
Howard Steiger, PhD
Eating Disorders Program
Douglas Hospital
Department of Psychiatry
McGill University
Montreal, Quebec, Canada
George Stricker, PhD, ABPP
Dept. of Clinical Psychology
American School of Professional Psychology at Argosy University, Washington DC
Arlington, VA 22209
Catherine Stroud, PhD
Department of Psychology
Williams College
Williamstown, MA 01267
Kristin C. Thompson, PhD
School Psychology Program
University of Arizona
College of Education
Tucson, AZ 85721
Johanna Thompson-Hollands, MA
Department of Psychology
Boston University
Boston, Massachusetts
Timothy J. Trull, PhD
Department of Psychological Science
University of Missouri,
Columbia, Missouri
Jeanne Watson, PhD
Dept. of Adult Education and Counselling Psychology
University of Toronto, Toronto
Canada, M5S 1V6
Joel Weinberger, PhD
Derner Institute of Advanced Psychological Studies
Adelphi University, Garden City, NY
Garden City, NY 11530
Thomas A Widiger, PhD
Department of Psychology
University of Kentucky
Lexington, Kentucky
Sandra M. Wilkniss, PhD
APA/AAAS Congressional Fellow
Arlington, VA 22205
Rachel Winograd, MA
Department of Psychological Science
University of Missouri,
Columbia, Missouri
David A. Wolfe, PhD
Center for Addiction and Mental Health
University of Toronto
Toronto, Ontario, Canada
Alexandra Zagoloff, PhD
Department of Psychiatry and Behavioral Sciences
Emory University
Atlanta, GA 30306

Part I


Chapter 1

Diagnosis and Classification