Lightner Witmer and the First 100 Years of

Clinical Psychology
Donal d K. Rout h
University of Mi ami
I I
Clinical psychology has developed over its first century in
certain ways that Witmer's work anticipated. These in-
clude clinicians' emphases on trying to help individuals
and on collaboration with physicians and other profes-
sionals and at least some continued emphasis on children's
academic problems. In other respects, the field developed
along lines Witmer did not anticipate." Clinical psychology
as it developed emphasized first the IQ, then other kinds
of testing, including projective and neuropsychological as-
sessment, and most recently clinical psychology has em-
phasized psychotherapy with adults more than children.
C
linical psychologists honor Li ght ner Wi t mer as a
pi oneer and cel ebrat e 1996 as t he cent enni al of
his foundi ng of t hei r field (he is also appropri at el y
honor ed as a founder of school psychology, of clinical
child psychology, and of pedi at ri c psychology). Wi t mer
ori gi nat ed t he first psychology clinic in 1896 and gave
t he field of clinical psychology its name (Witmer, 1907).
In 1907, Wi t mer also f ounded t he first scholarly j our nal
in this field, The Psychological Clinic, and t rai ned most
of t he first generat i on of clinical psychologists. Hi s stu-
dent s i ncl uded E. B. Twi t myer (University of Pennsyl-
vania), Stevenson Smi t h (University of Washington),
Francis N. Max field (Ohi o State University), and Davi d
Mitchell (the first clinical psychologist in i ndependent
practice). Wi t mer also served twice as presi dent of t he
Pennsylvania Association of Clinical Psychologists, t he
forerunner of t he Pennsylvania Psychological Association,
which was one of t he earliest state psychological associ-
ations (Knapp, Levin, & French, 1993).
However, it is obvi ous t o t he cont empor ar y observer
t hat t he field of clinical psychology has, in its first century,
developed in a number of di rect i ons not ant i ci pat ed by
its founder. It is t he purpose of this article t o discuss some
ways in whi ch Wi t mer ' s work bot h di d and di d not s e r v e
as a model for t he subsequent devel opment of clinical
psychology.
Wi t me r as a Rol e Mo d e l f or Cl i ni cal
Psychol ogy
Emphasis on Chi l dren's Academi c P robl ems
Before he ent ered t he field of psychology, Wi t mer t aught
hi st ory and English at a private pr epar at or y school in
Philadelphia (Collins, 1931). Ther e he encount er ed an
otherwise talented student with verbal deficits and t ut ored
him. Thi s young man went on t o successful work in col-
lege (t hough still struggling wi t h some difficulties), un-
doubt edl y encouragi ng some of Wi t mer' s opt i mi sm t hat
a dedicated teacher coul d be helpful t o such an individual.
Thi s proved t o be a format i ve experi ence for Witmer.
As is well known, t he first "case" t o be seen in Wit-
mer ' s psychological clinic at t he University of Pennsyl-
vani a in Mar ch 1896 was "Charl es Gi l man, " a school
child with spelling problems. In fact, the child' s probl ems
were br oader t han this t er mi nol ogy woul d i mpl y and in-
cluded reading and language mor e generally (Fagan, 1996,
this issue). After t he child' s visual difficulties were dis-
covered and correct ed, his educat i onal difficulties proved
t o be remedi abl e, and he went on t o academi c and vo-
cational success, confi rmi ng Wi t mer' s bel i ef t hat t he field
of psychology had somet hi ng t o offer in such cases.
It has oft en been stated t hat Wi t mer worked most l y
with "ment al l y r et ar ded" children. Thi s st at ement over-
looks t he fact t hat Wi t mer often used t he t er m retardation
t o describe t he situation in which a child has been retained
in grade a number of t i mes and, hence, is ret arded in
t er ms of school pl acement . In Wi t mer' s view, some such
chi l dren were i ndeed feebl e-mi nded and largely beyond
t he help of t he ki nd of i nt ervent i on he favored, but others
had remedi abl e difficulties. It was these ret arded but not
feebl e-mi nded chi l dren who were t he focus of his efforts.
In ot her instances, Wi t mer used the t er m retardation in
a mor e general way, for exampl e, t o describe del i nquent s
as being r et ar ded in t hei r mor al development.
Cont empor ar y clinical psychologists t end t o focus,
much mor e t han Wi t mer did, on the emot i onal and social
aspects of human life, rat her t han emphasi zi ng academi c
skills so much. Even in Wi t mer' s (1920) famous case of
" Don, " who would now probabl y be descri bed as an au-
tistic child, he emphasi zed t he success of his t r eat ment
in t er ms of t he youngst er' s subsequent academi c progress
( "t oday he is a nor mal boy, not qui t e seven years old,
reading, writing, and doing the number work of t he second
school year, " p. 97). A cont empor ar y t herapi st t reat i ng
Hel pf ul c o mme n t s on a pr el i mi nar y dr af t of t hi s art i cl e were pr ovi ded
by Th o ma s K. Fagan, Annet t e M. La Gr eca, Kr i s t i n Li ndahl , Paul
McReynol ds , J o h n Poppl est one, J o h n Re i s ma n, Mar i on Rout h, and C.
Eugene Walker.
Cor r es pondence concer ni ng t hi s art i cl e shoul d be addr essed t o
Dona l d K. Rout h, De p a r t me n t of Psychology, Uni versi t y of Mi a mi , P.O,
Box 248185, Cor al Gabl es, FL 33124.
244 Mar ch 1996 Amer i can Psychologist
Copyright 1996 by the American Psychological Association, Inc. 0003-066X/96/$2.00
Vol. 51, No. 3, 244-247
t he same child woul d pr obabl y emphasi ze t o a much
great er degree this chi l d' s obvi ous social, emot i onal , and
behavi oral progress.
As poi nt ed out in Fagan' s (1996) article in this issue,
Wi t mer' s emphasi s on chi l dren' s academi c pr obl ems has
been even mor e influential in t he devel opment of the field
of school psychology t han it was in t he clinical area. It
has been correct l y said t hat , aft er Worl d War II, school
psychology stayed home t o care for t he children, while
clinical psychol ogy went of f t o cohabi t with psychiatry.
Wi t mer ' s work was also influential beyond t he bor-
ders of psychology, for exampl e in special educat i on.
E. B. Twitmyer, Wi t mer ' s student, whose 1902 doct oral
dissertation on t he knee-jerk reflex anticipated Bechterev' s
di scovery of t he condi t i oned reflex, was one of t he found-
ers of speech therapy. Twi t myer' s now famous study, re-
por t ed in a paper t o t he Amer i can Psychological Asso-
ci at i on (APA) i n 1904 (the abst ract of whi ch was pr i nt ed
t he next year; Twitmyer, 1905), showed t hat aft er a num-
ber of trials, adults pr oduced ant i ci pat or y knee-j erk re-
sponses t o a bell t hat was r ung j ust before t hei r patella
was t apped with a hammer .
Hel pi ng Individuals
Wi t mer' s teacher, Wi l hel m Wundt , like ot her 19th cent ur y
exper i ment al psychologists, ai med t o st udy pr i mar i l y t he
generalized, nor mal adul t mi nd. In Wundt ' s view, psy-
chol ogy shoul d deal with average or t ypi cal per f or mances
mor e t han with individual variations. In this area, Wi t mer
followed t he exampl e of anot her of his teachers, James
McKeen Cattell (Woodwort h, 1944), r at her t han Wundt ,
in emphasi zi ng individual differences. However, Wi t mer
went far beyond ei t her Wundt or Cattell in advocat i ng
active clinical i nt er vent i on t o t r y t o i mpr ove lives of in-
dividuals, one at a time.
Wi t mer (1917) made it clear t hat as an i nt erven-
tionist, he model ed hi msel f aft er t he physi ci an- educat or s
J. M. G. Itard, Edouar d Seguin, and Mari a Mont essori
as well as Pereire, the pi oneer educat or of t he deaf. Indeed,
many of Wi t mer' s written case histories represent success
stories t hat mer i t compar i son t o t hose of t he Wild Boy
of Aveyron (Itard, 1801/1962) or t o t he "i di ot s" t r eat ed
by Seguin' s (1866) "physiological met hod. " Such case
histories cont i nue t o be inspiring t o t he clinician. Un-
fortunately, t hey oft en do not cont ai n sufficient detail in
t er ms of selection cri t eri a or t r eat ment pr ocedur es t o
per mi t confi dent replication. To this extent, t hey may
represent t he ar t mor e t han t he science of clinical
psychology.
Col l aborati on Wi th Physicians and Other
P rofessionals
The individuals seen in Wi t mer ' s clinic were commonl y
exami ned by physicians as well as by t he psychologist.
The well-known Phi l adel phi a physi ci an S. Weir Mi t chel l
was a close colleague of Witmer, and Wi t mer ' s best fri end
was t he neurol ogi st Joseph Collins. As earl y as 1896,
Wi t mer served on t he edi t ori al boar d of a pediatrics j our -
nal. The University of Pennsyl vani a' s hospital and med-
ical school were conveni ent l y l ocat ed onl y a bl ock away
f r om t he original psychology clinic. As Wi t mer' s clinic
developed, its staff came t o i ncl ude social workers and
teachers, as well as psychologists. As an exampl e of Wit-
mer' s frequent col l aborat i on with medi cal colleagues, it
was not unc ommon t hat chi l dren he worked with were
referred for medi cal exami nat i on t o see i f t hei r adenoi ds
were enlarged or diseased and i f t he physician recom-
mended t hei r removal. Unfort unat el y, as was also typical
of these case reports, no formal evi dence was ci t ed for
t he efficacy of this medi cal i nt ervent i on. It was i mpl i ed
t hat these adenoi d removals had psychological and aca-
demi c benefits, but this quest i on was apparent l y not for-
mal l y investigated.
Directions Not Anticipated by Wi t mer
The IQ
Early clinical psychology, when it came t o organizing itself
into a separate professional society in 1917 (Rout h, 1994),
was pr eoccupi ed by t he newly developed Bi net Scale. The
professional identity of early clinical psychologists, in t hei r
own est i mat i on as well as t hat of t he public, i ncl uded t he
role of t he Bi net tester. One pur pose of t he earliest profes-
sional organi zat i on of t he field was t o pr ot ect t he public
f r om i nadequat el y t r ai ned individuals at t empt i ng t o use
t he Bi net Test. It is, therefore, i nt erest i ng that, al t hough
Wi t mer came t o use the Bi net Test along with ot her tests
in his clinic, his appr oach was hardl y domi nat ed by it.
In fact, Wi t mer much preferred t o use his own tests, t he
Wi t mer For m Boar d (an adapt at i on of t he Seguin For m
Board) and t he Wi t mer Cylinders (an adapt at i on of t he
Mont essori Cylinders) in evaluating children. He used
these devices mor e as i nf or mal eval uat i on pr ocedur es
t han as standardized, nor med psychological tests. He
would typically have a child put t he blocks i nt o t he f or m
boar d repeat edl y and t r y t o see i f he coul d t each t he
youngst er t o do t he task correct l y and efficiently. He re-
fused t o concl ude on t he basis of any test score t hat a
part i cul ar individual was feebl e-mi nded, and he vi rt ual l y
never di d so wi t hout an ext ended peri od of t i me for "di -
agnostic t eachi ng. " In this respect, Wi t mer may well have
been ahead of his time. In t he opi ni on of several cont em-
por ar y researchers such as Feuerstein (1979, 1980) and
Haywood and Tzuri el (1992), t he field coul d well consider
ret urni ng t o such an appr oach t o evaluating children.
P rojective and Neuraps ychol ogi cal Testing
I am not aware of any ment i on of t he Rorschach (1921)
or ot her projective tests in Wi t mer ' s writings, t hough he
must have known somet hi ng about t hem. The clinical
use of projective tests is certainly widespread in t he Uni t ed
States and elsewhere in t he world but cont i nues t o be
controversial in some quarters. Some clinical psychology
i nt ernshi ps emphasi ze t he use of projectives, whereas
ot her programs avoid t hem. Thus, it r emai ns t o be seen
whet her Wi t mer' s hesi t ancy in endorsi ng this appr oach
t o assessment was justified or not.
Mar ch 1996 Amer i can Psychologist 245
Psychotherapy
Wi t mer was an i nt ervent i oni st , but probabl y no one
would have called hi m a psychotherapist. Rather, con-
t empor ar y psychot herapy developed out of t he work of
Freud and his followers, whi ch had a t r emendous influ-
ence on t he field of clinical psychology. Freud is consid-
ered a founder of psychotherapy, whi ch is one i mpor t ant
aspect of moder n clinical psychology. After all, Breuer
and Freud' s (1895/ 1955) first book on psychotherapy,
Studies on Hysteria, was publ i shed in 1895 (before Wit-
mer' s clinic was founded), and Fr eud (1926/ 1955) cham-
pi oned the right of nonmedi cal l y t rai ned individuals such
as Theodor e Reik t o practice psychoanalysis. However,
until recently, it was difficult in t he Uni t ed States for non-
physicians t o obt ai n psychoanal yt i c training.
Wi t mer never seemed t o have t aken Freud' s work
t oo seriously, al t hough he encouraged his graduat e stu-
dent s t o read psychoanal yt i c writings for themselves and
make up t hei r own mi nds about t hem. In this respect,
perhaps t he at t i t ude of Wi t mer t oward Fr eud was not
unlike t hat of many ot her students of Wi l hel m Wundt ,
t he founder of experi ment al psychology. For exampl e,
Emi l Kraepel i n, one of Wundt ' s most famous students
and one of t he leading psychiatrists of Europe, never pai d
much at t ent i on t o Freud' s work. Freud' s name is not even
listed in t he i ndex of Kraepel i n' s (1917/ 1962) book on
t he hi st ory of psychiatry. Wi t mer was not among those
who at t ended t he famous Cl ark University meet i ng in
1909 at which Fr eud and Jung spoke t o Americans.
Emphasis on Work With Adults
Fr om 1896 until World War II, clinical psychology fol-
lowed Wi t mer' s exampl e in emphasi zi ng work with chil-
dren rat her t han adults. This was due not only t o Wi t mer' s
personal influence but also to the exampl e of the physician
William Healy, t he founder of t he first child gui dance
clinic in Chicago in 1907. Later, the Commonweal t h Fund
suppor t ed t he devel opment of a nat i onwi de net work of
child gui dance centers, using Heal y' s preferred staffing
model of a psychiatrist, psychologist, and social worker.
The field of psychoanalysis also suppor t ed this t r end in
t hat several of t he most pr omi nent nonmedi cal analysts
including Anna Freud, Melanie Klein, and Er i k Eri kson
worked pr i mar i l y wi t h chi l dren.
After Worl d War II, t here was a mar ked change in
clinical psychology t oward work wi t h adults. The Uni t ed
States gover nment suppor t ed this change wi t h a massive
i nfusi on of t rai ni ng funds t o clinical psychology t hr ough
t he Veterans Admi ni st rat i on (now t he Depar t ment of
Veterans Affairs) and t he Nat i onal Inst i t ut e of Ment al
Health. These funds were also t he origin of t he Amer i can
Psychological Association' s system for accrediting doc-
t oral t rai ni ng and i nt ernshi ps in clinical psychology. The
Boulder Conference in 1949 ratified the recommendat i ons
of Davi d Shakow' s Commi t t ee on Trai ni ng in Clinical
Psychology t hat t rai ni ng in t he field i ncl ude pr act i cum
and i nt ernshi p experi ences as well as a research-based
PhD dissertation (Raimy, 1950).
For a while after t he Boul der Conference, it even
appear ed t hat the field of clinical psychology would be-
come completely occupi ed by work with adults. However,
in 1959, Alan Ross wrot e a book on t he pract i ce of what
he called clinical child psychology, giving an i mpet us t o
cont i nued work of clinical psychologists with children.
In 1962, a special section on clinical child psychology
was f or med in t he APA Division of Clinical Psychology.
At present, a number of t rai ni ng programs in clinical
psychology have a child emphasis or at least a specialty
t rack in t he child area. In fact, t he field of clinical child
psychology is thriving today. It can be concl uded t hat
clinical psychology has recovered f r om t he overemphasi s
on work exclusively with adults t hat charact eri zed t he
peri od i mmedi at el y following Worl d War II.
Empirical Evaluation of Treatments
Wi t mer' s j ournal , The Psychological Clinic, emphasi zed
case histories and pr ogr am descriptions. Most of Wi t mer' s
own writings appeared in this j our nal and were oft en case
histories. These case report s typically provi ded infor-
mat i on about how the case was referred, with t he initial
evaluation oft en i ncl udi ng test scores, a descri pt i on of
t r eat ment and out come, and follow-up over a per i od of
several years, somet i mes t hr oughout t he r emai nder of t he
individual' s life. Thus, one usually has a good basis for
evaluating the out comes as successful ones.
A cont empor ar y reader, accust omed t o articles in
clinical psychology publications such as t he Journal of
Consulting and Clinical Psychology, woul d find Wi t mer' s
case studies lacking in cert ai n expect ed features. Ther e
is usually not much of a reference list. Ther e is no i nt ro-
duct or y review of t he l i t erat ure nor a discussion section
setting t he case i nt o a cont ext of scientific findings. The
diagnostic mat eri al is present ed anecdotally. Similarly,
t reat ment progress and follow-up i nformat i on is report ed
verbally rat her t han by quant i t at i ve graphs or tables.
Cont rol groups are not used, nor is t here any ki nd of
single-subject experi ment al design t hat woul d allow one
t o concl ude t hat t he out come was t he result of t he treat-
ment s admi ni st ered. (In fairness t o Witmer, one should
poi nt out t hat none of his cont emporari es, including
Freud, were using such experi ment al met hods either).
Needless t o say, t here is no systematic investigation of
variations in t r eat ment of t he ki nd t hat woul d per mi t one
t o infer t he mechani sms of change. In short, one woul d
have t o concl ude t hat Wi t mer left much of his t hor ough
experi ment al psychology t rai ni ng behi nd hi m when he
ent ered the clinic. Collins (1931) says t hat Wi t mer' s orig-
inal presentation regarding clinical psychology at the 1896
APA meet i ng seemed t o pr oduce no response ot her t han
" a slight elevation of t he eyebrows on t he part of a few
of t he older member s" (p. 5). I believe t hat a Wi t mer case
hi st ory would elicit a similar response f r om any cont em-
por ar y reviewer in a clinical psychology j ournal .
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