Crucial Issues in the Field of Clinical and Community Psychology
by Victoria del Barrio, Open University, Madrid

One of the main characteristics in clinical psychology is its diversity. An example of this diversity, is that the theoretic frames applied in this are a are more numerous than in any other. Also the number of problems it encounters, even the number of people who cultivate it, is much larger than in any other specialty of psychology (DeSantis y Walker, 1991). This is why the challenge of analyzing the key problems in this area is twice as complex.

The main purpose of this paper is to analyze the problems that appear as most relevant in the near future for the Clinical and Community Psychology from a European perspective.

When someone tries to make predictions about the future, I always remember the phrase of Bernard Shaw: If I knew how the theater of thefuture was going to be, I would write it. Taking this as a starting point, I will try to analyze the main themes in modern Clinical Psychology, and I will do so by analyzing what we have been doing until now. Within the orthodox psychology, past behavior is the best predictor for future behavior.

This position may appear static, but it is simply evolutive, therefore dynamic. Knowing where we are is a good beginning to try to guess where we are headed, as long as there are no mutations, which, on the other hand, is something we cannot disregard.

For example, 30 years ago nobody could have known that many clinical psychologists would now be dealing with AIDS, because this problem was not predictable back then. The specter of AIDS is what we could compare to a social mutation or an unexpected change. Analyzing what psychology was doing 30 years ago in relation to health issues (taking care of the great killers that were heart, car, and cancer) we could have predicted that psychologists today would be taking care of the new great killer, even if we didnt know the name.

In this area we can be helped by the bibliometric techniques. Just like at its beginnings, clinical psychology through the analysis of the Psychological Abstracts had a profile that could be considered eminently physiological or psychodynamic (Belloch, Ibañez y Tortosa (1993)). Recent revisions about clinical psychology literature show a primacy of methodological and therapeutic matters (Carbonell et al., 1987). It is also possible to see the predominance of methodological and therapeutic matters in magazines like the Journal of Applied Behavior, and the Journal of Abnormal Psychology (Sos Peña, 1991). All this points to a consistency in the findings of different research.

The fact that clinical psychology is an applied science is something we must take into consideration. In fact, evaluation and intervention are two of its main goals. This implies that clinical psychology, on its practical side, is strongly related to the social changes to come.

The basically social implication of clinical psychology may be symbolized by the well-known change that took place in one American magazine: from Journal of Abnormal Psychology (1906) to Journal of Abnormal and Social Psychology (1925).

Clinical psychology, as an essential applied discipline, is mainly reactive when facing social demands. The consequence is evident: psychology will evolve along with the society it is immersed in.

Developed countries, pushed by the incredible power of technology, are bound to change, giving birth to a whole new set of problems and conflicts including: the growth of urban population, birth rate reduction, the increase of loneliness, extreme job specialization, the aging population, the birth of new diseases, the search for artificial pleasure, violence, these and others can be seen in the rising horizon of mankind. Undoubtedly many positive things come from all these changes, but it is also easy to foresee the many dangers that also come with them.

The applied nature of the field makes it necessary to acquire a deeper knowledge of the relevant aspects of everyday life, which influence the appearance of new life problems that will need to be analyzed from a clinical point of view. I am referring to very complex matters ignored or left aside, including falling in love, envy, experiencing success, or fidelity. These are highly relevant to normal and pathological life. There are few studies on these matters, and we need to go further into them.

Probably, as time goes by, the twentieth century will be remembered as the time when technology caused the most changes in its incorporation to the everyday life. Possibly, the most important consequence of all has been the change in the role of women. This change has been analyzed from a demographic and an economic point of view, and for its conquests and achievements. We have yet to study the deeper consequences that such new aspects of life has had on womens psychopathology.

Besides the matters that affect everyday life, there are also more theoretical aspects to be studied that may also represent new sources of conflict. Even though the different theoretical frameworks have coexisted throughout time, it is evident that the predominant framework is cognitivism. Today most of the production in clinical psychology is oriented by cognitive theories, even though there are clear signs that this theoretic point of view may already be in its way out, pushed aside by more organic views. In my view, the problem will be trying to conserve different perspectives and integrating different views.

Clinical Psychology may face more predictable problems in underdeveloped countries, because they will slowly become more similar to our own. Nevertheless, we must see a new problem arising from the close interaction between the First and Third World. While in the past a subordinated relationship would have normally occurred, today such dependence and inequality are no longer possible between them.

There is, in my opinion, a fact that may perfectly exemplify the many problems and communication difficulties between those two worlds. I am referring to the problem of communicating within our scientific community. Usually English-speaking researchers do not read anything but English, and are unaware of all that has been written in other languages. Undeveloped countries are paying attention both to English and non-English literature, while developed countries are only self-referent in psychology. This causes suspicion in Third World researchers, since they feel that they are somehow underestimated by their colleagues. Frustration produced by such incomprehension may lead to a pathological relationship.

All these and many more problems can be imagined by analysis of the present situation. We, clinical psychologists, must face them, providing a solution to a demanding society. Such solution must bring forth scientifically supported and efficient intervention. Hopefully, in the future of intervention, all actual techniques will be improved.

Probably many solutions will come from discoveries about the somatic basis of the most important illnesses and disorders. They will permit reduction of mental disorders, mental retardation, cancer, AIDS, Alzheimers disease -afflictions, that have until now put subjects in a difficult psychological position.

In our field, the most important challenge is primary prevention. It is the cheapest method of intervention, but also the one that requires the most time before seeing the results. Supporting institutions dont like to wait for a long time. We must change the values and mentality of our society.

Changing the way of life is a less intrusive and healthier way to promote physical and psychological well-being. Education in all fields is the best way to improve human lives. While secondary prevention has been carried out by acting directly upon individuals, primary prevention became more and more of a social nature, working with the techniques and methods of community psychology.

Intervention programs are then rooted both in social and clinical psychology. However, for good primary prevention we need to get to better know the risk factors and causes of different disorders, as well as the interaction of variables preceding a psychological dysfunction. These research goals will only be solved through close cooperation of academics and clinicians involved in private practice. A cooperative relationship between both fields is also desirable. Integration of different points of view, fields and disciplines is a first-order necessity if we want to solve all the problems considered here.

REFERENCES

BELLOCH, A., IBAÑEZ, E. & TORTOSA, F. (1983) Desordenes mentales, psicología anormal y psicología clinica: un proceso unitario? En H. Carpintero (Dir.) Historia y Teoría Psicológica. Valencia: Alfaplus.

CARBONELL, E. BURILLO, J. TORTOSA, F.Y. MONTORO L. (1987) El enfoque cognitivo en la clínica contemporanea, Revista de Historia de la Psicología, 3, 8, 3-104.

DeSANTIS, B.W. & WALKER, C.E. (1991) Contemporary Clinical Psychology. In C.E. Walker (Ed.) Clinical Psychology: Historical and Research Foundations. New York: Plenum Press.

ROUTH, D.K. (1994) Clinical Psychology since 1917 - Science, Practice, and Organization. New York: Plenum Press.

SOSPEÑA, R. (1991) La clínica psicológica actual desde dos perspectivas diferentes. Revista de la Psicología 12, 287-295.

Back to Contents Newsletter Spring 1996

Last modified: March 29th, 1996