American Psychologist

Copyright 1996 by the American Psychological Association, Inc.

Volume 51(3)             March 1996             p 244–247

Lightner Witmer and the First 100 Years of Clinical

Psychology
[1896: Lightner Witmer and The First Psychological Clinic]

Routh, Donald K.1,2

Department of Psychology, University of Miami.

1

Correspondence concerning this article should be addressed to Donald K. Routh, Department

2

of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124.

Helpful comments on a preliminary draft of this article were provided by Thomas K. Fagan,
Annette M. La Greca, Kristin Lindahl, Paul McReynolds, John Popplestone, John Reisman,
Marion Routh, and C. Eugene Walker.

Abstract
Clinical psychology has developed over its first century in certain ways
that Witmer's work anticipated. These include clinicians' emphases on
trying to help individuals and on collaboration with physicians and other
professionals 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 assessment, and most recently clinical psychology
has emphasized psychotherapy with adults more than children.

Clinical psychologists honor Lightner Witmer as a pioneer and celebrate

1996 as the centennial of his founding of their field (he is also
appropriately honored as a founder of school psychology, of clinical child
psychology, and of pediatric psychology). Witmer originated the first
psychology clinic in 1896 and gave the field of clinical psychology its name
(Witmer, 1907). In 1907, Witmer also founded the first scholarly journal in this
field, The Psychological Clinic, and trained most of the first generation of
clinical psychologists. His students included E. B. Twitmyer (University of
Pennsylvania), Stevenson Smith (University of Washington), Francis N.
Maxfield (Ohio State University), and David Mitchell (the first clinical
psychologist in independent practice). Witmer also served twice as
president of the Pennsylvania Association of Clinical Psychologists, the
forerunner of the Pennsylvania Psychological Association, which was one
of the earliest state psychological associations (Knapp, Levin, & French, 1993).

However, it is obvious to the contemporary observer that the field of

clinical psychology has, in its first century, developed in a number of
directions not anticipated by its founder. It is the purpose of this article to
discuss some ways in which Witmer's work both did and did not serve as a
model for the subsequent development of clinical psychology.

Witmer as a Role Model for Clinical Psychology

Emphasis on Children's Academic Problems

Before he entered the field of psychology, Witmer taught history and

English at a private preparatory school in Philadelphia ( Collins, 1931). There
he encountered an otherwise talented student with verbal deficits and
tutored him. This young man went on to successful work in college
(though still struggling with some difficulties), undoubtedly encouraging
some of Witmer's optimism that a dedicated teacher could be helpful to
such an individual. This proved to be a formative experience for Witmer.

As is well known, the first “case” to be seen in Witmer's psychological

clinic at the University of Pennsylvania in March 1896 was “Charles
Gilman,” a school child with spelling problems. In fact, the child's problems
were broader than this terminology would imply and included reading and
language more generally (Fagan, 1996, this issue). After the child's visual
difficulties were discovered and corrected, his educational difficulties
proved to be remediable, and he went on to academic and vocational
success, confirming Witmer's belief that the field of psychology had
something to offer in such cases.

It has often been stated that Witmer worked mostly with “mentally
retarded” children. This statement overlooks the fact that Witmer often
used the term retardation to describe the situation in which a child has
been retained in grade a number of times and, hence, is retarded in terms
of school placement. In Witmer's view, some such children were indeed
feeble-minded and largely beyond the help of the kind of intervention he
favored, but others had remediable difficulties. It was these retarded but
not feeble-minded children who were the focus of his efforts. In other
instances, Witmer used the term retardation in a more general way, for
example, to describe delinquents as being retarded in their moral
development.

Contemporary clinical psychologists tend to focus, much more than

Witmer did, on the emotional and social aspects of human life, rather than
emphasizing academic skills so much. Even in Witmer's (1920) famous case
of “Don,” who would now probably be described as an autistic child, he
emphasized the success of his treatment in terms of the youngster's
subsequent academic progress (“today he is a normal boy, not quite
seven years old, reading, writing, and doing the number work of the
second school year,” p. 97). A contemporary therapist treating the same
child would probably emphasize to a much greater degree this child's
obvious social, emotional, and behavioral progress.

As pointed out in Fagan's (1996) article in this issue, Witmer's emphasis on

children's academic problems has been even more influential in the
development of the field of school psychology than it was in the clinical
area. It has been correctly said that, after World War II, school psychology
stayed home to care for the children, while clinical psychology went off to
cohabit with psychiatry.

Witmer's work was also influential beyond the borders of psychology, for
example in special education. E. B. Twitmyer, Witmer's student, whose
1902 doctoral dissertation on the knee-jerk reflex anticipated Bechterev's
discovery of the conditioned reflex, was one of the founders of speech
therapy. Twitmyer's now famous study, reported in a paper to the
American Psychological Association (APA) in 1904 (the abstract of which
was printed the next year; Twitmyer, 1905), showed that after a number of
trials, adults produced anticipatory knee-jerk responses to a bell that was
rung just before their patella was tapped with a hammer.

Helping Individuals

Witmer's teacher, Wilhelm Wundt, like other 19th century experimental

psychologists, aimed to study primarily the generalized, normal adult
mind. In Wundt's view, psychology should deal with average or typical
performances more than with individual variations. In this area, Witmer
followed the example of another of his teachers, James McKeen Cattell
(Woodworth, 1944), rather than Wundt, in emphasizing individual differences.
However, Witmer went far beyond either Wundt or Cattell in advocating
active clinical intervention to try to improve lives of individuals, one at a
time.

Witmer (1917) made it clear that as an interventionist, he modeled himself

after the physician–educators J. M. G. Itard, Edouard Seguin, and Maria
Montessori as well as Pereire, the pioneer educator of the deaf. Indeed,
many of Witmer's written case histories represent success stories that
merit comparison to those of the Wild Boy of Aveyron ( Itard, 1801/1962) or to
the “idiots” treated by Seguin's (1866) “physiological method.” Such case
histories continue to be inspiring to the clinician. Unfortunately, they often
do not contain sufficient detail in terms of selection criteria or treatment
procedures to permit confident replication. To this extent, they may
represent the art more than the science of clinical psychology.
Collaboration With Physicians and Other Professionals

The individuals seen in Witmer's clinic were commonly examined by

physicians as well as by the psychologist. The well-known Philadelphia
physician S. Weir Mitchell was a close colleague of Witmer, and Witmer's
best friend was the neurologist Joseph Collins. As early as 1896, Witmer
served on the editorial board of a pediatrics journal. The University of
Pennsylvania's hospital and medical school were conveniently located
only a block away from the original psychology clinic. As Witmer's clinic
developed, its staff came to include social workers and teachers, as well
as psychologists. As an example of Witmer's frequent collaboration with
medical colleagues, it was not uncommon that children he worked with
were referred for medical examination to see if their adenoids were
enlarged or diseased and if the physician recommended their removal.
Unfortunately, as was also typical of these case reports, no formal
evidence was cited for the efficacy of this medical intervention. It was
implied that these adenoid removals had psychological and academic
benefits, but this question was apparently not formally investigated.

Directions Not Anticipated by Witmer

The IQ

Early clinical psychology, when it came to organizing itself into a separate

professional society in 1917 (Routh, 1994), was preoccupied by the newly
developed Binet Scale. The professional identity of early clinical
psychologists, in their own estimation as well as that of the public,
included the role of the Binet tester. One purpose of the earliest
professional organization of the field was to protect the public from
inadequately trained individuals attempting to use the Binet Test. It is,
therefore, interesting that, although Witmer came to use the Binet Test
along with other tests in his clinic, his approach was hardly dominated by
it. In fact, Witmer much preferred to use his own tests, the Witmer Form
Board (an adaptation of the Seguin Form Board) and the Witmer Cylinders
(an adaptation of the Montessori Cylinders) in evaluating children. He
used these devices more as informal evaluation procedures than as
standardized, normed psychological tests. He would typically have a child
put the blocks into the form board repeatedly and try to see if he could
teach the youngster to do the task correctly and efficiently. He refused to
conclude on the basis of any test score that a particular individual was
feeble-minded, and he virtually never did so without an extended period of
time for “diagnostic teaching.” In this respect, Witmer may well have been
ahead of his time. In the opinion of several contemporary researchers
such as Feuerstein (1979, 1980) and Haywood and Tzuriel (1992), the field could
well consider returning to such an approach to evaluating children.
Projective and Neuropsychological Testing

I am not aware of any mention of the Rorschach (1921) or other projective

tests in Witmer's writings, though he must have known something about
them. The clinical use of projective tests is certainly widespread in the
United States and elsewhere in the world but continues to be controversial
in some quarters. Some clinical psychology internships emphasize the use
of projectives, whereas other programs avoid them. Thus, it remains to be
seen whether Witmer's hesitancy in endorsing this approach to
assessment was justified or not.

Psychotherapy

Witmer was an interventionist, but probably no one would have called him
a psychotherapist. Rather, contemporary psychotherapy developed out of
the work of Freud and his followers, which had a tremendous influence on
the field of clinical psychology. Freud is considered a founder of
psychotherapy, which is one important aspect of modern clinical
psychology. After all, Breuer and Freud's (1895/1955) first book on
psychotherapy, Studies on Hysteria, was published in 1895 (before
Witmer's clinic was founded), and Freud (1926/1955) championed the right of
nonmedically trained individuals such as Theodore Reik to practice
psychoanalysis. However, until recently, it was difficult in the United States
for nonphysicians to obtain psychoanalytic training.

Witmer never seemed to have taken Freud's work too seriously, although
he encouraged his graduate students to read psychoanalytic writings for
themselves and make up their own minds about them. In this respect,
perhaps the attitude of Witmer toward Freud was not unlike that of many
other students of Wilhelm Wundt, the founder of experimental psychology.
For example, Emil Kraepelin, one of Wundt's most famous students and
one of the leading psychiatrists of Europe, never paid much attention to
Freud's work. Freud's name is not even listed in the index of Kraepelin's
(1917/1962) book on the history of psychiatry. Witmer was not among those
who attended the famous Clark University meeting in 1909 at which Freud
and Jung spoke to Americans.

Emphasis on Work With Adults

From 1896 until World War II, clinical psychology followed Witmer's
example in emphasizing work with children rather than adults. This was
due not only to Witmer's personal influence but also to the example of the
physician William Healy, the founder of the first child guidance clinic in
Chicago in 1907. Later, the Commonwealth Fund supported the
development of a nationwide network of child guidance centers, using
Healy's preferred staffing model of a psychiatrist, psychologist, and social
worker. The field of psychoanalysis also supported this trend in that
several of the most prominent nonmedical analysts including Anna Freud,
Melanie Klein, and Erik Erikson worked primarily with children.

After World War II, there was a marked change in clinical psychology
toward work with adults. The United States government supported this
change with a massive infusion of training funds to clinical psychology
through the Veterans Administration (now the Department of Veterans
Affairs) and the National Institute of Mental Health. These funds were also
the origin of the American Psychological Association's system for
accrediting doctoral training and internships in clinical psychology. The
Boulder Conference in 1949 ratified the recommendations of David
Shakow's Committee on Training in Clinical Psychology that training in the
field include practicum and internship experiences as well as a research-
based PhD dissertation (Raimy, 1950).

For a while after the Boulder Conference, it even appeared that the field of
clinical psychology would become completely occupied by work with
adults. However, in 1959, Alan Ross wrote a book on the practice of what
he called clinical child psychology, giving an impetus to continued work of
clinical psychologists with children. In 1962, a special section on clinical
child psychology was formed in the APA Division of Clinical Psychology.
At present, a number of training programs in clinical psychology have a
child emphasis or at least a specialty track in the child area. In fact, the
field of clinical child psychology is thriving today. It can be concluded that
clinical psychology has recovered from the overemphasis on work
exclusively with adults that characterized the period immediately following
World War II.

Empirical Evaluation of Treatments

Witmer's journal, The Psychological Clinic, emphasized case histories and

program descriptions. Most of Witmer's own writings appeared in this
journal and were often case histories. These case reports typically
provided information about how the case was referred, with the initial
evaluation often including test scores, a description of treatment and
outcome, and follow-up over a period of several years, sometimes
throughout the remainder of the individual's life. Thus, one usually has a
good basis for evaluating the outcomes as successful ones.

A contemporary reader, accustomed to articles in clinical psychology

publications such as the Journal of Consulting and Clinical Psychology,
would find Witmer's case studies lacking in certain expected features.
There is usually not much of a reference list. There is no introductory
review of the literature nor a discussion section setting the case into a
context of scientific findings. The diagnostic material is presented
anecdotally. Similarly, treatment progress and follow-up information is
reported verbally rather than by quantitative graphs or tables. Control
groups are not used, nor is there any kind of single-subject experimental
design that would allow one to conclude that the outcome was the result of
the treatments administered. (In fairness to Witmer, one should point out
that none of his contemporaries, including Freud, were using such
experimental methods either). Needless to say, there is no systematic
investigation of variations in treatment of the kind that would permit one to
infer the mechanisms of change. In short, one would have to conclude that
Witmer left much of his thorough experimental psychology training behind
him when he entered the clinic. Collins (1931) says that Witmer's original
presentation regarding clinical psychology at the 1896 APA meeting
seemed to produce no response other than “a slight elevation of the
eyebrows on the part of a few of the older members” (p. 5). I believe that a
Witmer case history would elicit a similar response from any contemporary
reviewer in a clinical psychology journal.

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