Table Of ContentMethods and Evaluation
in Clinical and
Counseling Psychology
THEODORE C. KAHN
JAMES T. CAMERON
Southern Colorado State College
Pueblo, Colorado
MARTIN B. GIFFEN
The University of Texas Health Science Center
San Antonio, Texas
PERGAMON PRESS INC.
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Copyright © 1975, Pergamon Press Inc.
Library of Congress Cataloging in Publication Data
Kahn, Theodore Charles.
Methods and evaluation in cHnical and counseling
psychology.
(Pergamon general psychology series - 40)
A revision and expansion of an earlier work by Theo
dore C. Kahn and Martin B. Giffen, published in 1960
under title: Psychological techniques in diagnosis and
evaluation.
Bibliography: p.
1. Clinical psychology. I. Cameron, James T.,
joint author. II. Giffen, Martin B., joint author.
III. Title. [DNLM: 1. Counseling. 2. Psychological
tests. 3. Psychotherapy. WM145 K13p 1975]
RC467.K3 1974 616.8'9Ό75 74-2002
ISBN 0-08-017862-6
ISBN 0-08-017863-4 pbk.
All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted in any form, or by any means, electronic, mechanical, photocopying,
recording or otherwise, without prior permission of Pergamon Press Inc.
Printed in the United States of America
This book is dedicated to our children:
Brent, Suzanne, Kathryn, Steven, Susan,
Donald, Cheryl, and Marsha
The Authors
Theodore C. Kahn (Ph.D., Southern California and Sc.D., University of
Mainz, Germany), internationally known psychologist and educator, is
Professor and Head of the Department of Behavioral Science, Southern
Colorado State College. He has served as senior counselor at the
University of California, psychological consultant to the Los Angeles
City School System, chief clinical psychologist for a number of large
diagnostic neuropsychiatric hospitals and community mental health
clinics, and has held teaching positions at the University of Southern
California, the University of Maryland, and Wittenberg University. Dr.
Kahn has won numerous national awards for research and teaching,
including Outstanding Educator in America. He has done pioneer work in
audio-visual-tactile rhythm therapy and introduced hominology, a new
way to view and study the whole man. Dr. Kahn is the author of several
books and numerous professional articles as well as the designer of a
number of psychological tests used in the United States and abroad. He is
the Founder and first President of the International Society of the Study
of Symbols and Honorary President of the Japanese Society for the Study
of KTSA.
James T. Cameron (Ph.D., University of Colorado) is Associate Professor
of Psychology at Southern Colorado State College and Director of the
Crisis Telephone Training Program. His other professional interests
include private practice, direction of a sensitivity training program, and
consultation and evaluation of educational and mental health programs.
Martin B. Giffen (M.D., The University of Pittsburgh School of Medicine)
is Professor of Psychiatry and Coordinator of the Residency Programs of
The University of Texas Health Science Center at San Antonio (Depart
ment of Psychiatry, The Medical School) and Director of Psychiatric
Inpatient Services of the Bexar County Hospital, San Antonio, Texas. His
primary interests are in the delivery of health care, forensic psychiatry,
the professional training of psychiatrists, psychologists, and medical
students, and development of concepts of acute and crisis triage facilities.
Dr. Giffen is a member of several professional societies and his published
works concern the use of hospital facilities and theory of forensic
psychiatry.
Preface
This book represents the collaboration of a professor of psychiatry at The
Medical School, The University of Texas Health Science Center, San
Antonio, Texas; a counseling psychologist, who is a counselor and an
associate professor of psychology at Southern Colorado State College;
and the Chairman of the Department of Behavioral Science at Southern
Colorado State College, who has had many years of practical experience
in the field of clinical psychology.
In effect, the book represents a greatly expanded edition of an early
work, Psychological Techniques in Diagnosis and Evaluation (Pergamon
Press, 1960) by Kahn and Giffen. The authors have rewritten the earlier
materials and brought them up-to-date. There are many new chapters in
addition to reviews and discussions on psychotherapy, counseling, in
novative methods, and other features not found in the earlier edition. Dr.
James T. Cameron has managed the production of this new book and as a
coauthor has added to it considerable material reflecting his experience as
a modern therapist and educator.
The authors attempted to bring to the reader the many-sided problems
that contemporary psychology faces. At the same time, the contributions
that psychology can make in many areas of human concern have been
described in some detail. We tried to answer as fully and clearly as
possible the question: What do modern practicing psychologists do, and
how do they do it? We wanted to make this answer intelligible to our
colleagues in the other professions that deal with human welfare—social
workers, correctional workers, and those who are employed in the
various specialties of medicine, law, the ministry, and education. The
xi
xíi Preface
book was also designed to be used as a textbook for courses in clinical
and counseling psychology. It was the intention of the authors to make
available to the reader the essential information that could explain the
kinds of methods, skills, techniques, and services that clinical and
counseling psychologists can render.
A serious effort was made to present both sides of controversial issues
and to give a balanced view throughout the book of all those topics that
are subject to differences of opinion. An attempt was also made to present
those methods, tests, and therapeutic techniques that are representative
of the contemporary scene in psychology. However, if one of the authors
had a special expertise or a unique experience within the field of clinical
psychology we did not hesitate to include information on the topic if we
felt that it might be of interest to the reader.
We also kept in mind that the reader might be interested in the future
role of psychology as a profession. Prediction is a hazardous matter;
however, a number of topics were selected in Appendix A that the
authors believed represent trends in the future development of psychol
ogy as a science and profession.
It is hoped that the reader, whether colleague or student of psychology,
will find the contents of these pages interesting and stimulating. Further
more, we hope that the book will give him an overview of that challenging
and sometimes puzzling profession—psychology as it is practiced today.
We wish to acknowledge with special gratitude the loyal support and
invaluable editorial contributions of Shirley Kahn, Jean Cameron, and
Margaret Giffen.
Theodore C. Kahn, Ph.D., Sc.D.
CHAPTER 1
Introduction
The recognition of clinical psychology as a bona fide member of the
psychological profession has less than 100 years of historical precedence.
It is a mere infant historically when compared with the older, more
established physical sciences. Even within the profession of psychology,
the clinician is considered a "late bloomer." In view of this, the growth of
the profession has been astonishing. Today, clinical psychologists consti
tute approximately 29 percent of all psychologists and, when combined
with the allied counseling field, this figure is increased to almost 40
percent [319].
Not only has the introduction of clinical psychology altered the
complexion of the psychology profession, but its internal composition has
constantly been subjected to experimentation, exploration, and an ever-
changing image. It is remarkable that this comparatively young profession
has attracted such a large number of members in less than a century while
still reflecting an unsettled and ever-evolving identity. A perusal of
historical antecedents and current movements may be helpful in bringing
this complex and sometimes conflict-ridden profession into perspective.
THE MEDICAL MODEL
It is impossible to discuss the history of clinical psychology as an
isolated movement. Other professions, especially medicine, have influ
enced the clinical identity of psychology. Even the name clinical—which
comes from the Greek word klinnikos, meaning "of the bed"—is adapted
from medical terminology.
2 Introduction
Medicine had the responsibility to treat the mentally ill and to provide
services for the maladjusted. Thus, clinical psychology initially was
modeled on the medical profession and psychologists concentrated their
efforts on the assessment and treatment of mental and physically related
pathologies. This alliance with the medical profession has provided the
clinician with a useful function but it has also led to some problems,
which will be discussed later. Other historical trends have affected the
professional development of the clinical psychologist. His commitment to
psychological research has guided much of his training and professional
behavior. A growing emphasis has been placed on the integration of
research and treatment and this has given the practice of clinical
psychology its identity.
Many different people have made significant contributions to the early
movement in clinical psychology. The humanitarian efforts of such people
as Philippe Pinel (who started the humanistic reform in mental institu
tions) in France during the 19th century, the crusades of Dorothea Dix
(American crusader for humane treatment of the mentally ill), and later
the work of Clifford Beers (founder of the National Committee for Mental
Hygiene and author of the book A Mind That Found Itself [35]) brought
about major changes in the physical conditions of mental asylums and in
the treatment of the mentally ill. Methods of diagnosis and treatment were
also being developed during this period. Emil Kraepelin established a
systematic method of classifying pathology by symptoms. His work had a
major influence on the early establishment of a diagnostic model for
pathology. Treatment, which was long neglected, was also being consid
ered. Jean Martin Charcot demonstrated how physical symptoms in
hysteria could be alleviated with the use of hypnosis. The impetus of his
early discoveries greatly influenced the work of Sigmund Freud and
others.
It was Freud more than any other individual who established the first
comprehensive system of psychological techniques for treatment.
Freud's impact was phenomenal and his contributions affected almost
every facet of psychology. Most important to the field of cHnical
psychology were Freud's theories, hypotheses, and explanations of
human behavior, particularly in the area of maladjustment. This, coupled
with his treatment method (which he termed psychoanalysis), supplied
the basic model for the many methods of therapy and the numerous
theories of abnormal behavior that followed. His work also provided the
stimulus for ensuing volumes of research that have greatly enhanced the
understanding of psychology.
The Scientific Model 3
Adherence to the medical model has given the clinician a useful and
recognized position in the field of mental health. However, for some
psychologists it has also led to some conflicts in professional role
identification. Even more basic to this problem than the medical model
was the psychologist's role in providing a variety of services to those who
suffered from pathology. Historically, the clinician perceived himself as
a provider of services to those who were ill; it was this position that
narrowed his vision to other aspects of clinical psychology in which he
participates today.
THE SCIENTIFIC MODEL
Other historical trends have affected the clinical model. The commit
ment of psychologists to legitimize the field of psychology as a science
has led to an emphasis on research and methodology, which has provided
structure for much of the academic training and professional experience.
The acceptance of the scientific method within psychology dates from the
early work of Wilhelm Wundt, who established the first psychological
laboratory in Leipzig, Germany, in 1879. The rigors of the laboratory
allowed Wundt to apply objective measures and to utilize strict controls
for his experiments. Possibly more important was the fact that the
program established by Wundt was utilized in the training of a number of
young psychologists who later became prominent and gave direction to
the new science of psychology.
Paralleling the work of Wundt was an equally ingenious laboratory
approach developed by Ivan Pavlov in measuring the connection between
a stimulus and a response. In his early work with dogs in the laboratories,
Pavlov [284] was able to create what he termed a "psychic secretion" by
pairing the tone of a tuning fork with meat powder blown into the animal's
mouth, causing salivation. The pairing was repeated a number of times
until the tone by itself could produce the response (salivation). Thus,
Pavlov demonstrated by the use of objective experimental methods that
behavior could be modified. It is from this basic premise that one
therapeutic approach in the area of behavior modification was devel
oped.
One of the students trained at Leipzig was Lightner Witmer. At the
University of Pennsylvania in 1896, this American psychologist adapted
his laboratory training and techniques to a clinical setting designed for the
assessment and treatment of emotional disorders in children. Witmer is
given credit for applying the term "clinical" in psychology and for
4 Introduction
demonstrating that the rigors of the laboratory can be utilized in a
practitioner's setting.
William James was another product of the Wundt laboratories. He
became the most influential American psychologist and his work carried
on Wundt's tradition of research and methodology. An even stronger
advocate of objective experimentation was John Watson, who rejected
the early ideas of introspection and, instead, stressed prediction and
control of behavior through rigorous objective methodology. He started
the behavioristic movement in the United States, which later fell into
disrepute but still has a number of adherents. Continuing psychological
inquiry into the area of learning were such researchers as E. L. Thorn-
dike, who proposed specific laws of learning, and B. F. Skinner, who has
become the major proponent of operant conditioning. The currently
popular behavior modification therapy can trace its roots to the basic
premises of these learning theorists.
MEASUREMENT OF INDIVIDUAL DIFFERENCES
The recognition and measurement of individual differences has also
made a unique and major contribution to the role of the clinical
psychologist.
Possibly from the first written notation of individual differences
(reflected in the disputed calculations of the distance to Venus by two
astronomers, Kennybrook and Maskelyne, in 1796) to the work of Charles
Darwin in the early 19th century, man has become increasingly aware of
individual differences and the need to measure and understand them.
Darwin's work stressed individuality and how differences made some
animals more adaptable than others. He emphasized the scientific ap
proach, which appealed to the infant science of psychology. However,
more important to the development of psychology was the work of
Darwin's cousin. Sir Francis Galton, who directly applied psychological
techniques to the study of individual differences in human behavior.
Galton's interest centered in the area of heredity and its effect on
individual differences. He carried out a number of studies on lineages of
successful, prominent families and also families who were marginal in
their adjustment. He recognized the need and provided the impetus for
the development of a quantitative method to validate his research. The
statistical techniques of correlation were developed by Karl Pearson from
a grant supported by Galton. Galton also designed a number of tests to
measure the various facets of individual differences, including intelli-
