Two different but related developments played an important role in the history of psychologists in the fields of mental health care in Germany during the 20th century. The first development took place in the field of applied psychology, which saw psychological professionals perform mental testing, engage in counseling and increasingly, in psychotherapy in practical contexts. This process slowly began in the first decades of the 20th century and included approaches from different schools of psychotherapy. The second relevant development was the emergence of clinical psychology as an academic sub-discipline of psychology. Having become institutionalized in psychology departments at German universities during the 1960s and 1970s, clinical psychology often defines itself as a natural science and almost exclusively focuses on cognitive-behavioral approaches. There are four phases of the growing relationship between psychology and psychotherapy in Germany in which the two developments were increasingly linked: first, the entry of psychology into psychiatric and psychotherapeutic fields from approximately 1900 until 1945; second, the rise of psychological psychotherapy and the emergence of clinical psychology after World War II until 1972, when the diploma-regulations in West Germany were revised; third, a phase of consolidation and diversification from 1973 until the pivotal psychotherapy law of 1999; and fourth, the shifting equilibrium as established profession and discipline up to the reform of the psychotherapy law in 2019. Overall, the emergence of psychological psychotherapy has not one single trajectory but rather multiple origins in the different and competing academic and professional fields of mental health care.
Mind cure, or mental healing, was a late 19th-century American healing movement that extolled a metaphysical mind-over-matter approach to the treatment of illness. Emerging in New England in the mid-19th century out of a mix of mesmerism and metaphysical philosophies, due to its effectiveness, by the 1880s it achieved national recognition. Three individuals are credited with creating and popularizing mental (or metaphysical) healing: Phineas Parkhurst Quimby, Warren Felt Evans, and Mary Baker Eddy. Mind cure was appealing because it helped treat ailments for which the medicines of the day were ineffective, especially problems with the “nerves.” Mental healers employed non-invasive mental and spiritual methods to treat ailing people, called mental therapeutics. As a practice and therapeutic philosophy, mind cure is historically noteworthy because it shaped the earliest forms of psychotherapy in the United States, advanced therapeutic work within the realm of mind-body medicine, birthed the influential New Thought movement, and helped set the stage for the beginnings of religious pluralism and the positive reception of Asian meditation teachers in the West.
Wade E. Pickren and Ingrid G. Farreras
In a relatively brief period of time, the discipline of psychology in the United States changed from being mostly concerned with its status as a legitimate science, qua physics or biology, to a rapidly growing field caught up in the tensions between academic science and the practice of psychology as a mental health profession. The numerical growth of the field’s members was heavily concentrated in the professional areas of mental health application. This was due primarily to the changed conditions of postwar life and the concerns of policymakers about the mental health of citizens in a dynamic, fast-changing, and fast-paced society. Government funding for psychology dramatically increased, especially funds for training clinical psychologists and for conducting research on mental health problems. It was not long before many of the clinical psychologists moved away from solely academic work and into the private practice of providing psychotherapy to clients. The discipline’s main organizational body of the time was the American Psychological Association, which came under pressure to allocate intellectual, organizational, and financial resources to the support of its practitioner members. One of the most intense battles of this period was that of creating different training models for clinical psychology. The early postwar model placed priority on training clinical psychology students to be scientists first, but by the 1960s, the demand for greater emphasis on training for practice had to be addressed for the field to remain coherent. Along with the internal tensions, psychology had to come to terms with external pressures as well. Among its challenges were those from competing professions, such as medicine, to its legal and cultural authority to provide professional services. Psychology eventually won those battles, but only after a state-by-state fight. Psychology was also presented with the challenges of a society wrestling with social problems, such as the demands for equal civil rights and opportunities. By the late 1960s, there were increasing demands for inclusion of students and faculty of color in graduate training and while there were some successes, there remained challenges that endured into the 21st century.
Scott O. Lilienfeld and Candice Basterfield
Evidence-based therapies stemmed from the movement toward evidence-based medicine, and later, evidence-based practice (EBP) in psychology and allied fields. EBP reflects a progressive historical shift from naïve empiricism, which is based on raw and untutored observations of patient change, to systematic empiricism, which refines and hones such observations with the aid of systematic research techniques. EBP traces its roots in part to the development of methods of randomization in the early 20th century. In American psychology, EBP has traditionally been conceptualized as a three-legged stool comprising high-quality treatment outcome evidence, clinical expertise, and patient preferences and values. The research leg of the stool is typically operationalized in terms of a hierarchy of evidentiary certainty, with randomized controlled trials and meta-analyses of such trials toward the apex. The most influential operationalization of the EBP research leg is the effort to identify empirically supported treatments, which are psychotherapies that have been demonstrated to work for specific psychological conditions. Still, EBP remains scientifically controversial in many quarters, and some critics have maintained that the research base underpinning it is less compelling than claimed by its proponents.