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Contemporary systems psychology and integrated approaches to school and

clinical service delivery: Reincarnations of Lightner Witmer’s “Psychological
Clinic”

Article · September 2012

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 Contemporary Systems Psychology and
Integrated Approaches to School and Clinical
Service Delivery:
Reincarnations of Lightner Witmer’s
“Psychological Clinic”
Dillon Browne, Heather Prime, and Mark Wade
University of Toronto

Abstract
Lightner Witmer is often credited as the founding father of “clinical psychology” largely due to his formation
of the first psychological clinic in 1896, followed by the creation of the first periodical dedicated to
psychological practice a decade later. An analysis of Witmer’s approach to treatment will reveal that he
envisioned an integrated discipline, one that was unified yet multidisciplinary and based upon a systemic
understanding of the developing person. This approach was intended to blend aspects of psychology with
medicine and pedagogy in order to provide comprehensive services and best ameliorate various psycho-
physiological conditions. Three main occurrences contributed to the marginalization of Witmer’s approach
from clinical psychology: the rise of the psychotherapeutics and psychoanalysis movement, Witmer’s
alienation from the mainstream American psychological community, and the emergence of an independent
school psychology. Today, new research, theory, and training models are pushing applied psychology
towards a unified, multidisciplinary perspective. A historical comparison will reveal that these developments
are not unlike Witmer’s original vision.

Keywords:Lightner Witmer, School Psychology, History of Psychology, Multidisciplinary, Service

Integration

When discussing the origins of psychological practice, few scholars would omit the historical founding of
the first Psychological Clinic by Lightner Witmer in 1896 (Resnick, 1997). Around the turn of the 20th century,
Witmer and a multidisciplinary team of physicians, educators, and psychologists from the University of
Pennsylvania were providing services to children who were struggling in the educational system and other contexts
(Witmer, 1907). After a decade of science, practice, and advocacy, Witmer’s work had sufficiently grown in
support and popularity, resulting in his decision to form the first journal devoted to psychological practice. This
periodical was appropriately dubbed the Psychological Clinic (Witmer, 1907). The versatile use of this term is an
exemplification of the multifaceted and integrated nature of Witmer’s approach, which he called “clinical
psychology” (Witmer, 1907, p. 9). Unfortunately, even though these formative events are over a century in the past,
historians of psychology have indicated that many psychologists know very little of Witmer’s work and his
approach to applied psychology (Benjamin, 1996). Moreover, it has been suggested that the clinical methods used
today are not reflective of Witmer’s approach (Routh, 1996). A historical examination of Witmer’s Psychological
Clinic – both as an institution and as a discussion forum of science and practice – will reveal that Witmer never
intended for clinical psychology to become segregated from other helping professions, particularly medicine and
school psychology. These developments are partially attributable to: (a) the psychotherapeutics and psychoanalysis
movement; (b) Witmer’s personal alienation from the greater psychological community in America; and (c) the rise
of an independent school psychology.
Correspondence concerning this article should be addressed to Dillon Browne, Department of Human Development &
Applied Psychology, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, Ontario
M5S 1V6 Canada; email: brownedt@gmail.com.

September 2012 ● Journal of Scientific Psychology 102

 Today, both clinical and school psychologies are becoming better integrated in a comprehensive health
system of treatment and care (Benjamin, 2005; Nastasi, 2000). However, as defined by Witmer, clinical psychology
was always intended to be a holistic treatment enterprise, where scientist-clinicians collaborated and provided a new
approach to the amelioration of many psycho-physiological conditions, integrating traditional medical and
pedagogical approaches with psychological science. Moreover, this psychology was intended to be a self-correcting
enterprise, combining the application and evaluation of psychological methods of treatment, constantly improving
the manner in which these services were provided. Indeed, Witmer envisioned a unified yet multifaceted discipline
that possessed many progressive and innovative ideas that were lost or ignored over the course of the 20th century
(Routh, 1996). These ideas have re-emerged in many new and improved forms including systems theories of child
development (e.g., Bronfenbrenner, 2005; Lerner, 2006) and service utilization (Browne, Verticchio, Shlonsky,
Thabane, Hoch, & Byrne, 2010), integrated service delivery approaches (Browne, Roberts, Gafni, Byrne, Kertyzia,
& Loney, 2004; Burchard, Atkins, & Burchard, 1996) and even training models, most notably in the School and
Clinical Child Psychology training model (Geva, Wiener, Peterson-Badali, & Link, 2003). The current paper will
examine Witmer’s early work in relation to the historical discontinuity in the practice of psychology.
Recommendations will be provided to support the growing body of literature that integrates education, clinical
psychology, school psychology, developmental psychology, and health systems approaches.
Before continuing further, a few definitions will be laid out for the purposes of semantic organization.
First, when referring to systems psychology, we are describing the collective theoretical, scientific, and applied work
of psychologists who seek to understand and improve human psychological functioning through the application of
systemic organizing principles (namely, that the individual is best understood by examining the relationships among
the constituent parts of the individual and their context, rather than these parts as isolated units).
Next, a historical distinction must be made between school and clinical psychology for the purposes of this
paper. Differences here refer both to the location of practice (i.e., a school setting versus a hospital, clinic, or private
practice) and the content of assessment and intervention. It has been our experience that the school psychologist is
often mistaken for a “tester” who is primarily concerned with psychoeducational assessment. Such assessments
often include an evaluation of social-emotional and behavioral problems inasmuch as they impact a child’s ability to
succeed in the classroom. Consultation or brief counseling take place, but psychotherapy remains the domain of the
clinical psychologist, while environmental restructuring is the role of the social worker, and educational remediation
the role of the educator. Though we are not arguing against specialization, a novel re-visitation of Witmer’s work
will reveal that both Witmer and contemporary systemic thinking calls for a more integrated relationship between
school and clinical approaches, along with other service models, within the practitioner. Finally, when we speak of
service integration, we are referring to (a) the strategic alliance of comprehensive health and psychological
treatment and prevention services, (b) occurring across service provider disciplines and agencies at different levels
of care, (c) into a unitary and individualized service program for individuals and families.
Witmer and the Psychological Clinic
In 1867, Lightner Witmer was born in Philadelphia, Pennsylvania, to parents David and Katherine
(McReynolds, 1997). Education was very important in the Witmer home. Consistent with the collective optimism
and pride following the Union victory in the American Civil War, David, a pharmacist, demanded the best
opportunities for his children (Thomas, 2009). Despite the family’s modest income, Witmer, the eldest of four
siblings, attended the prestigious Episcopal Academy of Pennsylvania (McReynolds, 1997). In 1884, Witmer
enrolled in undergraduate studies at the University of Pennsylvania, beginning as an art major though later switching
to finance and economics (Thomas, 2009). After completing his baccalaureate, Witmer postponed his graduate
studies to teach English and History for two years at a boys rugby academy (McReynolds, 1997). In 1889, Witmer
began graduate studies at the University of Pennsylvania, first in philosophy, then in political science, and finally in
psychology under James McKeen Cattell, who was in the process of developing the experimental psychology lab. It
should be noted that Witmer continued to teach students while enrolled in graduate school, a decision which likely
influenced his pedagogical approach to psychological treatment (Thomas, 2009). However, in 1891, Cattell moved
to Columbia University. Witmer, now without a supervisor, finished his PhD under Wilhelm Wundt in Germany,
where he was encouraged to study visual forms rather than individual differences, as he had originally planned
(McReynolds, 1997). His dissent for the Wundtian nomothetic approach to psychological study, influenced by the
time he spent with Cattell, would be reflected in his ideographic approach to treatment (McReynolds, 1997). In
1892, at the age of 25, Witmer returned from Germany and took charge of the position that was vacated by Cattell,
becoming head of the psychological laboratory at the University of Pennsylvania (McReynolds, 1997).
The Psychological Clinic was originally a system of practice that was conducted in Witmer’s laboratory
and funded by the University of Pennsylvania, though private sources of funding would also emerge in later years
(McReynolds, 1997). The first case occurred in 1896 when a Philadelphia teacher, Miss Margaret T. Maguire,

September 2012 ● Journal of Scientific Psychology 103

became concerned in response to a student’s inability to develop spelling proficiency (Witmer, 1907). Also
studying psychology at the University of Pennsylvania, Miss Maguire astutely reasoned that someone in the
laboratory, who possessed a thorough understanding of human mental functions, should be able to identify the
causes of this disability and provide some guidance (Benjamin, 1996). This supposition fit incredibly well with
Witmer’s paradigm, who had already conducted extensive work in pedagogical remediation while working as an
instructor (Witmer, 1907). The child, identified under the pseudonym “Charles Gilman”, was successfully treated
and went on to achieve a satisfactory level of academic and occupational functioning (Routh, 1996). Contemporary
scholars (McReynolds, 1997) and Witmer himself (1907) have marked this case as the unofficial beginning of
Clinical Psychology.
As word spread, parents, teachers and school administrators from greater Philadelphia began to contact the
clinic due to concerns regarding children’s “inability to progress in school work” and unresponsiveness to discipline,
which Witmer referred to as “moral defect” (Witmer, 1907, p. 1). In light of increasing case complexity, Witmer
quickly expanded his approach to include the practice of medicine, whereby pedagogical and psychological
approaches were simultaneously employed in conjunction with a traditional medical model during the assessment
and treatment processes. Witmer’s practice was also ecological. People from different levels of the child’s context,
including teachers, parents, and administrators, collaborated with physicians and the new helping psychologists to
provide services (Watson, 1956). This is exemplified by Witmer’s account of a typical case (1907): based on the
recommendation of a school superintendant, parents brought their 10 year old son to the clinic. He appeared to be
completely illiterate. Witmer first employed his team of physicians to determine if any fundamental medical
anomalies were to blame. A family history was taken, ruling out hereditary grounds for the problem. Then the
neurologist, Dr. William G. Spiller, ensured the absence of general “mental degeneracy and of physical defect” (p.
1). Following this, oculist Dr. William C. Posey examined the boy’s vision, only finding a mild astigmatism which
was corrected. Finally, an ear, nose and throat specialist, Dr. George C. Stout, checked for enlarged adenoids and
provided a clean bill of health. Witmer’s team also included prominent Philadelphia physician and writer Dr. Silas
Weir Mitchell who helped with examinations. Once other causes for the impairment were ruled out, Witmer would
conduct psychological testing. Also, in collaboration with the child’s teachers, direct instruction was employed in
an attempt to ameliorate the deficit while permitting conclusions to be drawn surrounding the child’s intellectual
capacities (Witmer, 1907). State-of-the-art psychometric assessment technologies were used, including the Binet
Scale along with the Witmer Form Board and Witmer Cylinders, the latter two being modifications of Seguin’s and
Montessori’s measures, respectively (Routh, 1996). In addition to direct remediation, treatment focused on
environmental restructuring in order to create behavior change (McReynolds, 1997). Though the above description
may sound standardized, Witmer’s approach, which is comprehensive even by today’s standards, was ideographic
and responsive to the unique needs of individual children (McReynolds, 1997; Thomas, 2009).
Ten years after the original case, Witmer formed a journal called the Psychological Clinic, providing a
forum in which proponents of the “clinical” approach could disseminate their case studies and evaluate the
effectiveness of various treatment modalities for certain case presentations (Witmer, 1907). Witmer noted his
reticence in forming the periodical, waiting until a significant following and rigorous methodology had emerged
before formally announcing the viability of this approach on a large scale (Witmer, 1907). He may have also been
discouraged by the questionable reception of his controversial, perhaps premature, account of clinical psychology
when addressing the American Psychological Association in 1896 (Thomas, 2009). Nevertheless, Witmer’s
persistence succeeded, resulting in the formation of a discipline that was based on the application of systematic and
scientific methods for helping persons overcome psycho-physiological dysfunction. Although Witmer called his
approach Clinical Psychology, his methodology would be omitted from the repertoires of later practitioners who
identified themselves as “clinical”. By and large, the methods were modified and taken up in a sub-discipline
known as “school psychology” (Fagan, 1996). Before discussing this development, however, the innovative merits
of Witmer’s approach will be outlined.
Foundations of a New Discipline
Witmer’s application of psychological principles to the helping enterprise has been described as “ahead of
its time” even though there were, of course, already a variety of historical approaches for helping people with mental
problems (Thomas, 2009). The novelty of Witmer’s approach lies in the way he uniquely synthesized and integrated
the strengths of multiple professions and areas or scholarship. During the 18th and 19th centuries, treatment of the
mentally ill largely took place in lunatic asylums under the supervision of medical professionals (Benjamin, 2005).
Witmer’s approach was influenced by progressive thinkers from this era, including Jacob Rodrigues Pereira (1715-
1780), who taught language to the deaf, and Philipe Pinel (1745-1826), who fought for institutional reform and
moral treatment of psychiatric patients. Witmer (1907) also drew upon themes from Jean-Jacques Rousseau’s
(1712-1778) commentaries on the importance of pedagogy in promoting civilized society and social responsibility.

September 2012 ● Journal of Scientific Psychology 104

In this respect, Witmer’s work was characterized by the marriage of traditions of sociology, pedagogy, and, of
course, the philosophical schools of psychological thought in which Witmer was trained, including American
Functionalism. Additionally, Witmer (1907) indicated that his vision of clinical psychology was closely aligned
with medicine and psychiatry due to its emphasis on treatment or intervention. As mentioned, his approach involved
a “conjoint medical and psychological examination” of a patient, followed by “a diagnosis of the child’s mental and
physical condition and the recommendation of appropriate medical and pedagogical treatment” (emphasis added, p.
1). Witmer (1907) made it clear that the focus of the psychologist is on the welfare of the individual child.
However, a dedication to the advancement of science through detailed case analysis attempted to ensure that this
happened effectively and on a large scale.
Witmer’s empirical evaluation of treatments would obviously not meet today’s scientific and empirical
standards for evidence-based practice (e.g., Kazdin, 2002), as his journal published mainly case reports and
descriptions of individual treatment programs (Benjamin, 1996; Routh, 1996). Despite this, the forming of the
Psychological Clinic periodical indicates Witmer’s emphasis on having informed and evidence based treatments.
Additionally, his theoretical approach to treatment is remarkably consistent with current “systems models” of human
development, namely, Developmental Systems Theory (DST; Lerner, 2006), Ecological Systems Theory
(Bronfenbrenner, 2005) and Dynamic Systems Theory (Fogel, 2011). Today, these principles have been applied to
ecologically valid methods of assessment and treatment, including Developmental-Systems Assessment (Mash &
Hunsley, 2007), Multisystemic Therapy (e.g., Sheidow, Henggeler, Schoenwald, 2003) and the Positive Parenting
Program (Sanders, 2012). First and foremost, these systems theories fall under the banner of Relational Meta-
theory, whereby atomism, reductionism, and artificial splits between various levels of human and social organization
are replaced by an emphasis on the relationships of component parts into an irreducible whole (Overton, 2006).
While Witmer never formed a coherent theory of development, his assumptions on the nature of human ontogenesis
are implicit in his approach to treatment. Most important is the focus on multiple levels of organization when
conceptualizing the etiology, diagnosis, and treatment of any particular problem (Witmer, 1907). The majority of
patients at the Psychological Clinic were children with learning difficulties. However, the exclusive relegation of
Witmer’s approach to an educational “school psychology” is not consistent with history (Fagan, 1996). In fact,
Witmer formally opposed the sectioning of an exclusive state association for school psychology (Fagan, 1996). In
line with this, practitioners at the psychological clinic would apply their multidisciplinary assessment and treatment
programs to patients, ranging from early childhood to adulthood, who suffered from a variety of ailments (Witmer,
1907). Parents were also included in assessments and treatment regimens. In a review of records from Witmer’s
clinic, McReynolds (1997) notes that referrals were originally provided almost exclusively by school personnel,
though as the clinic’s popularity grew, they would eventually come from a variety of sources including physicians,
probation officers, judges, and other service providers. Records indicate that patients with epilepsy, brain trauma,
Down’s syndrome, and “nervousness” were assessed and treated, in addition to children who were “morally
delinquent”, “incorrigible” or who had “uncontrollable tempers” (p. 238). It should be noted that Witmer also
maintained a commitment to experimental psychology, publishing a laboratory manual and collaborating with E.B.
Titchener. Such a diversified yet integrated orientation suggests that Witmer did not intend clinical psychology to
be “independent” of medicine and education as some have suggested (e.g., McReynolds, 1997, p. 237). Rather, his
approach was to be a comprehensive and holistic system of health and social service delivery that complimented and
synthesized existing modalities.
Witmer’s approach was also consistent with the systemic premise that individual development is the
product of real-time interactions between various levels of individual organization. As proffered by Dynamic
Systems Theory, these dynamic interactions occur on the micro-scale and are responsible for maintaining relatively
enduring macro-scale psychobiological phenomena (Fogel, 2011). For example, Witmer acknowledged that sensory
physiology can interact with cognitive aptitude, influencing an individual’s ability to process and learn information
in scholastic, tutorial or occupational settings, thereby determining their developmental trajectory as a learner or
employee. Equally important for Witmer was the nature in which individuals interacted with their contexts in a
reciprocal fashion, thereby producing developmental outcomes. Today, these sentiments can be seen in the
recognized concepts of proximal processes (Bronfenbrenner, 2005), person-context interactions (Lerner, 2006), and
child-environment transactions (Sameroff, 2009). The centrality of the person-context system for Witmer is
illustrated by his emphasis on environmental restructuring when outlining treatment programs (McReynolds, 1997).
Also consistent with systemic thinking (and contemporary neuroscience), Witmer was a believer in the relative
plasticity of psychological functioning and held an optimistic view concerning the nature of humanity. Despite his
employment of medical models, he did not view his clients as “pathological”, but simply saw them as deviating
from the average due to their functioning at a lower or “retarded” stage of development (Witmer, 1907, p. 9). It was
the clinical psychologist’s role to help the child obtain an optimal level of functioning and overcome any retardation.

September 2012 ● Journal of Scientific Psychology 105

This positive orientation is mirrored today in the contemporary “developmental asset building” approach (Lerner &
Benson, 2002). Despite this positive emphasis, however, the assessments at the clinic did not fall victim to the
“happy face syndrome”, whereby asset building approaches are employed to the exclusion of necessary deficit
reduction and remediation (Lyons, 2004). In fact, Witmer’s approach identified weaknesses during the assessment
so that treatment could simultaneously reduce deficits and promote strengths. When viewed in this light, Witmer’s
approach to psychological practice seems remarkably progressive, consistent with non-reductionist accounts of
human psychological functioning and comprehensive models of intervention. However, a number of occurrences
would cause his work to become compartmentalized from mainstream clinical psychology.
The Marginalization of Witmer’s Approach
Today, Witmer’s role in clinical psychology is often viewed through the lens of advocacy and institution
building rather than theoretical contribution to practice (McReynolds, 1997). The marginalization of Witmer’s
methods can be attributed to: (a) the rise of psychotherapeutics and psychoanalysis, (b) personal factors that may
have alienated him from the American psychological community, and (c) the emergence of a unique school
psychology.
Taylor (2000) suggested that clinical psychology, as defined by Witmer, and psychotherapeutics, which
would develop into psychoanalysis, emerged separately and independently. Witmer’s program was more heavily
influenced by the scientific laboratory techniques of Germany. On the other hand, the psychotherapeutics
movement was influenced by physiological psychology in addition to neurology and psychical research, including
the study of mediums, telepathy, and clairvoyance (Taylor, 2000). The rise to prominence of psychotherapy and
psychoanalytic theory in the early part of the twentieth century spawned one of the greatest challenges to the basic
tenets of Witmer’s holistic, person-centered approach to care. Though the attack was by no means directed at
Witmer himself, the problem came on two levels: first was widespread acceptance of the fascinating (though
notoriously infalsifiable) theories of Sigmund Freud and Carl Jung which, by the 1930s, took a foothold in
mainstream psychology by offering a compelling and seemingly unified theory of child development (Cairns &
Cairns, 2006). Some proponents of psychoanalytic theory even boasted of “universal validity” and being “granted
the right of judgment” towards other domains of psychological specialty (Freud, 1931, p. 561). The intended
monopolization of psychological theory and practice by Freudian and post-Freudian movements left little room for
theoretical dissent, especially for underdeveloped or implied theories like those of Witmer. Indeed, despite
unsuccessful attempts to experimentally authenticate the purported hallmarks of psychoanalytic theory (e.g.,
fixation, projection, etc.; see Sears, 1944), the Freudian movement continued to permeate both theory and practice
through the middle part of the twentieth century (Cairns & Cairns, 2006). Though Witmer himself did not have a
well-annunciated theory of child development, his affinity for empiricism left him at odds with traditional
psychoanalysts. For example, in Volume Two of The Psychological Clinic, Witmer attacked Elwood Worcester and
the Emmanualism movement along with Hugo Munsterberg’s hypnotic treatment of alcoholism due to poor
application of the scientific method and for blending spirituality with psychology (Thomas, 2009). In an attempt to
further disentangle basic philosophy and applied psychology, he personally criticized William James’ interest in
mysticism and the occult, calling him a “litterateur” rather than a psychologist (McReynolds, 1997, p. 145). James
was not concerned by the attack, but Munsterberg called for Witmer’s removal from the American Psychological
Association, a request that was never fulfilled (Thomas, 2009). In sum, Witmer’s rejection of the highly influential
psychoanalytical framework appears to have ostracized him from the psychology community, perhaps thwarting any
effort to conjure a theory of development and practice that could gain general recognition.
A second set of challenges posed to Witmer by the psychoanalytic enterprise involved the fundamental
alterations it made to the landscape of clinical psychology in the United States. Heavily endorsed by G. Stanley Hall
in the early 1900s, the popularity of psychoanalysis had spread to America when Freud and Jung were invited to
speak at Clark University in Massachusetts in 1909. However, by the 1930s there was a decisive split of
psychoanalysts into an array of heterogeneous groups, each with varying ideas around the importance of key
psychoanalytical concepts (Monroe, 1955). At first blush this may appear to have strengthened the opportunity for a
Witmerian upsurge, but the fractured enterprise presented another layer of complexity that threatened psychological
practice. Specifically, Freudian descendants in America made it a requirement that only physicians (i.e., those with
medical degrees) could be trained in and practice psychoanalysis (see Ekstrom, 2002). The instantiation of a
medically-based, Newtonian model into the most prominent psychological orientation of the time undercut the
credibility of non-medical practitioners, including those who employed more systemic therapeutic approaches
(Costello & Costello, 1992). The exclusionary nature of psychoanalysis in the United States contrasted with the
models that originated in Vienna (Schwartz, 1999), but even Freud himself became an advocate for the medical
framework in America (Freud, 1931). The schism between American psychoanalysts and the international
community rendered the medically-based approach as a leading form of psychological treatment in the United States

September 2012 ● Journal of Scientific Psychology 106

(Ekstrom, 2002). Witmer, who diametrically opposed Freudian concepts, would inevitably fail to impact the
psychoanalytically-dominated field of psychology. Indeed, Witmer’s obituary suggested that his “aggressively
honest and critical demeanour”, coupled with his rejection of the extremely influential “analytically oriented”
psychology, would cause his approach to be avoided by practitioners who considered themselves “clinical”
psychologists (Watson, 1956, p. 680).
Paralleling the removal of his methods from the clinical realm was the uptake of his psycho-educational
methods in the discipline of “school psychology”. In addition to Witmer’s contributions, this approach traces many
of its origins back to G. Stanley Hall’s work on individual differences in children and Alfred Binet’s contributions to
psychological testing (we would like to thank an anonymous peer reviewer for input on this point). In the early
1890s, Hall, unsatisfied with the use of single case studies on children, undertook a program of questionnaire studies
on child development. Hall’s contributions are considered to have been the impetus for the Child Study Movement,
which Hall himself described as, “… devoted to the collection, diffusion, and increase of the scientific knowledge of
childhood” (Hall, 1910, p. 160). Witmer's orientation was primarily idiographic and, as such, was focused on
individual children. Hall’s orientation, on the other hand, was nomothetic; he was focused on the context within
which children developed, with the aim of changing the developmental system and child pedagogy. As Fagan
described, “What Hall studied normatively, Witmer tried to correct individually” (Fagan, 1992, p. 238). It was the
carrying of the Child Study Movement into the realm of the atypical child that characterized the role of the school
psychologist (Fagan, 1992). Indeed, in 1915, a student of G. Stanley Hall named Arnold Gesell became the first
practitioner with the title of “school psychologist” in the United States (Braden, Di Marino-Linnen, & Good, 2001).
Gesell’s role was to assess children and provide recommendations for special treatment. Particularly instrumental to
identifying children as requiring special education was Alfred Binet’s development of mental abilities testing. He
published what is considered to be the first modern intelligence test in 1905, the Binet-Simon scale, allowing the
measurement of both normative functioning as well as degrees of mental retardation. In addition to providing a
measure that permitted the identification of children with deficiencies, the scale provided a benchmark from which
other measures of cognitive ability could be evaluated (French, 1987).
Although clinical and school psychologies have never been completely segregated in practice, many have
argued that the treatment of psychopathology and socio-emotional maladjustment has historically been the domain
of clinical psychologists, whereas the assessment and amelioration of problems pertaining to scholastic learning has
concerned the practice of school psychology (Nastasi, 2000). Mental ability tests, although critical in identifying
children who required special education, kept school psychologists in the role of “testers” for much of the 20th
century (Sarason, 1976). Indeed, a paradox has persisted: time allocations have been primarily dedicated to
assessment in order to meet special education requirements of school districts; however, many acknowledge that
school psychologists should continue to expand their roles into consultation, counseling, and therapy in order to
provide best services to children in need (Fagan, 2002). Today, there is an accumulating body of evidence
articulating the bidirectional relationship between children’s learning and mental health, revealing a continuing need
to bridge the gap between school and clinical psychology (Adelman & Taylor, 1999; Fagan, 2002; Nastasi, 2000).
Consistent with Witmer’s century-old vision of a unified psychological practice, the unreasonable and artificial
nature of this dichotomy has begun to reach critical mass.
School and Clinical Psychology Today: Partners in Integrated Service Delivery
In a review of the history of clinical psychology, Benjamin (2005) notes that Witmer remains influential
despite the fact that clinical psychological practice today does not mirror his methods. Although this may be true for
some clinicians who are principally involved in adult psychotherapy, we must note that one of Witmer’s
fundamental principles has regained favour: successful assessment and treatment necessitates the simultaneous and
integrative examination of functional domains that are organized under medical, socioemotional, and academic
(occupational) levels of organization. Despite a misinterpretation of Witmer’s vision for a unified “clinical”
approach, Benjamin (2005) cogently argues that the continued progression of clinical psychology necessitates the
development of multidisciplinary solutions to the world’s most pressing issues such as disease, mental illness,
healthcare, education, income inequality, poverty, pollution, crime, child abuse, and conflict. In a similar vein,
psychological practitioners who have operated in academic settings are now explicit about the importance of
addressing multifaceted and complex problems in their clients (Nastasi, 2000). Like the “clinical” orientation, the
“school” psychologist is in a unique position to address the issues of today, providing comprehensive healthcare in a
multidisciplinary and contextually sensitive fashion through the application of direct services and consultation
(Nastasi, 2000). Viewed in this light, it appears that the collective understanding in both clinical and school
psychology has arrived at the same conclusion, one not unlike Witmer’s orientation 100 years ago. Though there
have been many subsequent developments in psychology that Witmer did not anticipate (Routh, 1996), Witmer’s
initial emphasis on the treatment of an irreducible person from a multidisciplinary framework remains true.

September 2012 ● Journal of Scientific Psychology 107

 Of course, one of the defining features of psychological practice is its inexplicable link to research, science,
and regulated training. Witmer (1907) rejected all artificial splits between “basic” and “applied” research,
suggesting that the value of all science is its ability to advance the progression of humanity. Beginning in 1897,
Witmer and his colleagues promoted the growth of his method by overhauling the psychology curriculum at the
University of Pennsylvania. The program included experimental and physiological psychology, child psychology,
and a practical component demonstrating the clinical method in action (Witmer, 1907). Witmer’s training program,
which represented a combination of research and practice, was expanded and solidified at the historical 1949
conference in Boulder, Colorado. This meeting, run by the American Psychological Association and funded by the
newly formed National Institute of Mental Health, marks the formal adoption of the “scientist-practitioner model”
by clinical, school, and counseling psychology (Benjamin, 2005). Sixty years have passed since the Boulder
conference and the training model remains influential. However, advancements in developmental theory, research,
and practice have led to the formation of related, yet augmented models that are well suited to guide psychologists
and other integrated service providers into the future. Three sub-models will be highlighted that can be synthesized
into a unified approach of systems psychology and integrated service provision: (1) the service integration approach
in healthcare, (2) the family-standpoint of investigation in developmental science, and (3) the School and Clinical
Child Psychology (SCCP) training model.
The Service Integration Approach
Witmer is one the first integrated health service providers in modern history. One hundred years before the
principles were formally outlined by prominent developmental scientists (Cicchetti & Rogosch, 1996), Witmer’s
program of treatment recognized that there can be multiple distinct causes to any single symptom or set of
symptoms. Today, this is known as the principle of multifinality (Cicchetti & Rogosch, 1996). Commensurate with
this, contemporary psychologists and health service providers articulate the importance of integrated care or
integrated service provision. The idea is that treatment is most effective when the multiple sources of
psychopathology, educational-occupational struggle, and other general medical conditions are addressed
simultaneously. The most comprehensive model of integrated service delivery to date is Browne and colleagues’
conceptualization (2004) which is a tripartite model organizing integration on three axes (see Figure 1): (1) vertical
axis – sectors to be integrated, where a sector refers to an area of care that is usually grouped together due to funding
restrictions or historical developments; (2) horizontal axis – the types of service, that form a continuum of care
ranging from universal (prevention), targeted (early intervention) and clinical (family development, support,
remedial and therapeutic); and (3) oblique axis – funding sources, which may include public, private, and non-profit
or voluntary. Based on Witmer’s aforementioned clinical approach, it is clear that he was an integrator of services
(mainly across psychology, medicine and education), and provided supports via the psychological clinic at different
levels of the continuum of care (i.e., severity). To date Witmer’s funding sources remain a topic of minimal
discussion (see Routh, 1994, for a historical perspective on the early economics of clinical psychology).
The Family Standpoint of Investigation
The Family Standpoint of Investigation is a theoretical perspective integrating phenomena at child-level
and health and social service-levels by examining their interconnections with family-level processes, and broader
contextual risks, across development (Browne et al., 2010, see Figure 2). It most heavily draws upon
Developmental Systems Theory (Lerner, 2006), but is consistent with all systems approaches in psychology
(Bronfenbrenner, 2005; Fogel, 2011; Sameroff, 2010). Its main utility is in understanding the ways in which
children, families and healthcare systems can become connected in a transactional and dynamic child-family-service
system. It was generated in response to calls for theoretical frameworks and empirical research that examines
developmental processes across multiple levels of social and individual organization (Overton, 2006). The
framework was first explicated and demonstrated in the context of child welfare, where the relationships between
risky family environments, child adjustment, and service utilization patterns (including education and child
protection) were examined. Any constructs that are organized at child, family, and service levels are amenable to
study using this framework, such as genetics, psychophysiology, emotions, behavior, cognition and academic
functioning at the child level; parenting, sibling interaction, marital conflict, maternal depression, and other forms of
economic and contextual risk at the family level; and utilization expenditures, service wait-lists, access to care,
quality of care, and service integration at the service level. Again, it is understood that the child-family-service
system is embedded in a broader school, community, and geo-political contexts characterized by variable levels of
risk (and their own proximal processes) consistent with Ecological Systems Theory (Bronfenbrenner, 2005).
Studies can be focused on within-level (e.g., child) or cross-level (e.g., child-family, or child-family-service)
research questions (Cicchetti & Valentino, 2007). Also, the measurement of constructs at one level (e.g., service
level) may take place from the vantage point of that level (e.g., medical records) or may be embodied within another
level (e.g., parental perceptions of the quality of care that their child is receiving; Smart et al., in revision).

September 2012 ● Journal of Scientific Psychology 108

Moreover, constructs may be operationalized at a particular level of organization, measured at that level of
organization, or both. For example, a researcher may be interested in the levels of maternal depression (a family-
level construct) within different health maintenance organizations or healthcare networks (a service-level of
measurement). Conversely, a researcher may be interested in the extent to which caregivers (a family-level of
measurement) approve of the psychological and health services their families receive (a service-level construct). A
researcher who is interested in parent perceptions of family functioning is both conceptualizing and measuring at the
same level of analysis.
The main utility of the family standpoint of investigation is to encourage researchers to think about child,
family, and health and social service research questions in a systemic fashion, thereby examining the complex
relationships among the constituent parts of the child-family-service system, rather than the components in isolation.
The family is a critical junction between child functioning and service levels, in particular, because (a) family and
child functioning are reciprocally influential, where the afflictions of either level can detrimentally impact the other;
(b) children and families with psychological problems use more educational, psychological and healthcare services,
thereby costing more money; and (c) children with adjustment problems and who are at high risk navigate the school
and clinical service systems with their families, not alone (Browne et al., 2010).
School and Clinical Child Psychology Training Model
The School and Clinical Child Psychology (SCCP) approach is a pedagogical model that provides
theoretical and professional training in preparation for psychological work with children, adolescents, and families
in school, mental health, private practice, and research settings (Geva et al., 2003). The program title includes the
term “child psychology” due to its developmental emphasis, though adult training and research occurs as adults are
key members of the child-family-service system. There several central tenets that differentiate this model from
other psychological training programs: a) emphasis is placed on the extensive overlap of school and clinical
orientations including ethics, development, psychopathology, assessment, interviewing, therapy, diagnosis,
consultation, research, and evaluation; b) the program is a scientist-scholar-practitioner model, whereby broad
general knowledge is encouraged outside of an individual’s areas of expertise in research and practice; c) attention is
paid to normal and abnormal development, diversity, and contextual factors; and d) students are guided through the
Master’s and PhD with mentorship from a primary advisor, though collaboration and clinical supervision from other
faculty members also occurs. Not unlike Witmer’s paradigm, the most important characteristic of the model is the
rejection of dualist splits between a child’s academic and psychosocial functioning (Geva et al., 2003). Students are
educated in both medical models and systems perspectives, providing a well-informed and adaptable approach to
research, practice, and scholarship.
In terms of psychoeducational and social-emotional assessment, students are trained in a variety of
orientations including classical psychoeducational models, response to intervention, functional analysis, and most
notably, developmental-systems assessment (Mash & Hunsley, 2007). The latter is defined as:
a range of deliberate assessment strategies for understanding both disturbed and non-disturbed children and
their social systems, including families and peer groups. These strategies employ a flexible and ongoing
process of hypothesis testing regarding the nature of the problem, its causes, and likely outcome in the
absence of intervention, and the anticipated effects of various treatments. (Mash & Hunsley, 2007, p. 6).
The Witmerian approach is remarkably consistent with this statement. Indeed, like developmental systems, Witmer
(1) argued for an idiographic approach; (2) focused on systemic, situational, and ecological influences; (3) was more
concerned with cognition, behavior, and affects that were pertinent to presenting problems rather than latent causes;
(4) sought information from assessment that would be directly informative to treatment (i.e., treatment planning and
selecting treatment targets); (5) engaged in a multi-method, multi-informant type of assessment to understand
situational stability versus variability; and (6) believed in an evidence-based and self-correcting enterprise, where
assessment using response to intervention occurred within the context of a single assessment, and evaluation of
effective strategies were disseminated and moved the field forward (Mash & Hunsley, 2007). Though Witmer
would not have been engaging in psychotherapy as we know it, students in the SCCP model are exposed to most
movements and schools in psychotherapy, and can receive extensive training in modalities that meet criteria for
evidence-based practices (Kazdin & Weisz, 2011), including cognitive behavior therapy, contemporary
psychodynamic psychotherapy, dialectical behavior therapy, multisystemic therapy, acceptance and commitment
therapy, family therapy, play therapy, and mindfulness-based treatments.
A number of scientists and clinicians are conducting research that melds systems psychology, service
integration perspectives, the family standpoint, and an integrated school and clinical psychology. Interestingly,
these studies share a number of substantive and theoretical similarities with Witmer’s early vision. For example,
Wade and colleagues have demonstrated that the same organizing principles underlying the etiology of
psychopathology are applicable to the emergence of poor school readiness (Wade, Prime, Browne, & Jenkins,

September 2012 ● Journal of Scientific Psychology 109

2012). That is, the determinants of early academic success are small, multiple, probabilistic, and interact with one
another across levels of organization in order to produce deleterious consequences. Similarly, Browne and
colleagues (2010; 2011) are currently examining how patterns of child adjustment and health/social service
expenditures (including educational resources) can be tied to a variety of constructs that operate at the family level,
such as parental stress and family functioning. Browne concludes that the social importance of family-level
constructs such as parental stress have been understated due to research that focuses solely on child- or family-level
outcomes, ignoring the way in which affected persons operate in broader social, educational, healthcare, and
economic contexts. In a similar vein, Wiener and colleagues have demonstrated how the correlates of hyperactivity-
inattention operate across child, family, and social levels of analysis, including psychosocial and academic
outcomes, school variables, peer factors, and family stressors in their conceptual framework (e.g., Rogers, Wiener,
Marton, & Tannock, 2009). One study of children with complex disabilities and their families indicated that both
service integration and child hyperactivity-inattention were independently associated with family functioning
(Browne, Rokeach, Wiener, Hoch, in revision). Moreover, hyperactive children (and their parents) had the highest
utilization expenditures at baseline, though these effects were ameliorated over the course of involvement with
integrated mental health and medical services. Such research that examines the sequelae of adversity from a
multidimensional framework is best situated to understand the phenomenon in question and provide fully informed
treatment and policy recommendations. Moreover, it is important for such work to take a multicultural perspective.
For example, Geva and colleagues (2000) have demonstrated the importance of culturally sensitive service delivery
and developmental theory when working in school and clinical contexts. Cultural competence is becoming
increasingly important in a global context characterized by urbanization, growing diversity, and increasing gaps
between the rich and the poor.
Consistent with Witmer’s approach to science and practice, these programs of study indicate that
psychological variability in individuals is best understood by examining the influences and correlates of various
physiological processes, personal histories, and societal forces in an integrative framework. These comprehensive or
systems perspectives can be contrasted with reductionist explanations, including psychoanalysis, learning theory,
behavioral genetics, or sociogenic models, that attempt to understand all psychological phenomena though a
restricted spectrum of possible influences (Lerner, 2006).
General Recommendations for Science, Practice, and Training
Before concluding, several recommendations for science, practice, and training will be articulated based on
the theoretical premises of systems psychology and integrated service delivery. None of these recommendations are
necessarily new, in their own right, and other comprehensive sources are available in this area (Damon & Lerner,
2006; Gutkin & Reynolds, 2009; Rutter et al., 2008; Weiner, 2002). Many methods date back to Witmer, himself.
However, they are being re-articulated for purposes of completeness in the present discussion and historical review.
Also, it should be noted that the following recommendations are more pertinent to the way which science and
practice are best conceptualized within the universe of developmental theory, as opposed to recommendations on
specific methodological or intervention practices themselves. References are available on specific evidenced based
treatements, as well (Barlow, 2008; Kazdin & Weisz, 2010).
First and foremost, theoretical frameworks and approaches to treatment should be based on the organizing
principles of relational meta-theory (Overton, 2006; von Bertalannfy, 1968), whereby reductionist splits amongst the
units of a system in question are avoided and, rather, the complex, reciprocal, and symbiotic relationships amongst
the constitutent parts are viewed as paramount. As described above, a number of prolific theories have been
articulated in line with these organizing principles, with empirical evidence to boot. Also, treatments and
intervention programs are becoming increasingly sensitive to ecological and cultural constraints, as is the case with
multisystemic therapy, parent management training, and the positive parenting program. Moreover, theoreticians
should continue to integrate additional levels of analysis to their research questions, measured across the lifecourse,
thereby approximating the full range of antecedents and consequences that are centered around psychological
maladjustment and human suffering. This has also been seen in pratical applications for service delivery, both in
and outside of clinical and school psychology, as is the case with the Service Integration perspective and the
Wraparound Process.
It is imperative the empirical validation of these theories and treatment modalities are making use of state-
of-the-art statistical techniques. In other words, mathematical models must be adequately complex and
comprehensive in order to best approximate the realities postulated by the theoretical frameworks. Techniques may
include analyses that permit the simultaneous testing of cumulative and indirect effects (e.g., mediated moderation
and moderated mediation), effects at different levels of organization (multilevel modeling, dyadic data analysis, and
social relations models), latent variable analyses including the identification of mixtures of homogenous subgroups
of people (e.g., structural equation modeling, latent class/profile analysis), univariate longitudinal methods across

September 2012 ● Journal of Scientific Psychology 110

the micro (seconds) and macro (years) time scales (growth curve analysis, latent class growth analysis), multivariate
longitudinal methods (growth mixture models, cross-lagged simultaneous equations), and the on-going integration
of these models with behavioral genetic and other genetic designs in order to disentangle the effects of heredity and
environments. Software packages capable of fitting such models are becoming increasingly available and user-
friendly. Moreover, mathematical model-building approaches should be complimented by ideographic methods
such as single-subject research designs (Homer et al., 2005).
In addition to the modeling itself, it is imperative that state-of-the-art measurement is taking place across
levels of organization in order to best understand the phenomenon in question. This is true for both naturalistic and
therapeutic effects, and the corresponding moderators, mediators, and consequences surrounding academic,
occupational, cognitive, and social-emotional domains. In addition to traditional psychometric, academic, and
observational measurement methods, such measures should include mirco-level assessments from genetics, biology,
physiology, endocrinology, and neurology. These often take the form of physiological indicators such as functional
polymorphisms on candidate genes, hormones such as blood or salivary cortisol and oxytocin, epigenetic indicators
such as DNA methylation and acetylation, and neural patterns based on neurological and neuro-imaging techniques,
including EEG, fMRI, PET, and CT scans. Measurement should also be extended to macro-level assessments,
traditionally used in fields of economics, epidemiology, geography, political science, demography, population
health, and applied statistics. While biological markers present unique technological challenges and requirements,
such macro-level measurement often requires data-linkage, information-access partnerships, and political
cooperation. When possible, it is preferable to have (anonymous) individually linked data, including results from
standardized educational testing, medical records, and other social service utilization patterns. Such paradigms
permit researchers to ask questions based on naturalistic phenomena, and understand the consequences of naturally
occuring interventions. The field of psychology is in a unique position to integrate such quantum and molar levels
of human understanding within the experience of an integrated and conscious human organism. It is important that
scientists-scholar-practitioners are being trained with competence in such domains, as is the case with the School
and Clinical Child Psychology model.
Conclusion
The presented analysis of Witmer’s clinical psychology reveals a remarkably advanced approach to science
and practice, one that possesses many of the organizing principles of an integrated systems psychology and model of
service delivery, today. Indeed, many of the recomendations proffered above were apparent in the work done at
Witmer’s Psychological Clinic at the University of Pennsylvania. Unfortunately, a variety of occurences saw the
emergence of relatively independent “clinical” and “school” streams of psychology. Over time these were
increasingly separated from medicine, which has been similarly characterized by reductionism and dualist spits. As
described above, the main reasons for the marginalization of Witmer’s approach include (a) the rise of the
psychoanalytics and psychotherapeutics movement, to which Witmer was adamantly opposed; (b) Witmer’s
corresponding alienation from the greater psychological community due to his outspoken opposition and tendencies
for, perhaps, harsh criticism; and (c) the emergence of an independent school psychology, one that took on many of
Witmer’s pedagogical strategies but neglected to see the systemic thinking that was perhaps too implicit in his work.
As mentioned, the approach closest to Witmer has been traditionally employed by pedagogical
psychologists, while clinical psychology has experienced its own independent evolution. Of course, school and
clinical psychology today are a century more advanced than Witmer’s orientation, reflective of the efforts of many
other influential scientist-scholar-practioners, statistical and technological advancements, and developments across
various domains of science. However, even though the direct linkage is limited, it is reasonable to conclude that
Witmer’s clinical psychology was an ancestor of today’s various “systems” approaches which reject the viability of
any single grand mechanism of development or human psychology in favour of a more pragmatic understanding of
people that is both nuanced yet holistic (Lerner, 2006). It would be misinformed to say that progress was not made
during the years where grand theories of development dominated the landscapes of psychology departments. In fact,
these theories remain influential today and provide interchangable lenses through which researchers and practioners
can view any particular phenomena, all the while remaining faithful to particular meta-theoretical and systemic
organizing principles. Nevertheless, it is important to note that the current systems movement is not completely
unprecedented. A historical understanding of multidisciplinary and systemic thinking in applied psychology, and
particularly the role of Lightner Witmer, can contribute to the continued development of an integrated discipline.
Consistent with Witmer’s vision over a century ago, the future of a unified psychology lies in the hands of scientist-
scholar-practitioners who encourage the study and application of comprehensive and innovative methods of
ameliorating human suffering and promoting positive growth. This is especially true of approaches that selectively
apply systems thinking in conjunction with pedagogical, psychological, and medical treatment models, thereby
providing the best integrated treatment services possible.

September 2012 ● Journal of Scientific Psychology 111

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Figure 1. Graphical model illustrating the Tripartite Model of Service Integration, where integration occurs across
service sector, service type, and funding sources (adapted from Browne and colleagues, 2004).

September 2012 ● Journal of Scientific Psychology 114

 Figure 2. Graphical depiction of the Family Standpoint of Investigation, embedded in a developmental and
ecological system over time (adapted from Browne and colleagues, 2010).

September 2012 ● Journal of Scientific Psychology 115

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