Diagnosis - Reflective Essay

Running head: 190051753 PSM611 1
Reflecting on how Diagnosis Interfaces with the Ethos of Counselling Psychology
Word count: 820
In counselling psychology, the psychologist actively consumes and contributes to
objective, scientific research; meanwhile, the counsellor’s therapeutic practice is underscored by
a humanistic value base that recognises the unique and relational nature of human beings and
seeks to promote wellbeing. Together, both the objective and subjective realms in which
counselling psychologists operate produce the creative tension which embodies their work.
From this, the scientist-practitioner model has emerged in order to capture how empirical
research and the collaborative exploration in therapy of clients’ subjective experiences and their
personal meanings can complement each other. By sourcing objective, academic research as
evidence for one’s therapeutic work with an individual in distress, one might feel confident in
predicting a desirable outcome for that client. Currently, in the UK, psychological distress is
clinically assessed using psychiatric diagnosis.
Diagnosis is an established way of separating distinct forms of distress into individual
disorders, each characterised by a cluster of symptoms (i.e., subjective complaints). The most
popular system by which to classify psychiatric distress is the Diagnostic and Statistical Manual
of Mental Disorders (DSM), currently in its fifth edition. This approach to dealing with
psychological distress follows the medical model, which for its own purposes seeks to match
bodily complaints to a meaningful pattern of empirically supported symptoms to ensure correct
treatment and from which to make predictions about outcome.
However, the problem with diagnosing most forms of psychological distress in the same
way as organic disease is the difficulty in proving a biological basis. For example, with
psychoses, for which there is little to no hard evidence to support a biological cause, making a
190051753 PSM611 2
diagnosis based on symptoms involving thoughts, feelings and behaviours will result in a
subjectively drawn label ‘coated’ in medical language. Whereas multiple doctors can observe
and confirm a diagnosis of a sexually transmitted infection from objective signs such as the
presence of chlamydia in the urine, in psychiatry the subjective complaint “I feel sad” could lead
to any number of diagnoses subject to several factors. This points to the issue of reliability.
Reliability is the degree of consistency, in this case, between judgments made about the
correct diagnosis. If two or more clinicians agree upon a diagnosis, they have established inter-
rater reliability. In psychiatry, however, this criterion is rarely satisfied, which is unsurprising
given that DSM criteria are replete with subjectivity. Furthermore, if diagnoses are not reliable,
they cannot be valid. A diagnosis cannot reflect real life if only half of all clinicians agree upon
it.
Another problem with validity is that psychiatric diagnosis is a product of social values
insofar as they only reflect the ‘norms’ within that society. A recent example of a mental illness
classified based not on empirical research but on social attitudes is homosexuality. If we only
later realised this was inappropriate, how are we to know the same is not happening today? If
disorders are culture-bound, that is, based on Western notions of abnormality, many individuals
will be stuck with a psychiatric label that simply does not reflect their values: for example, in
Eastern cultures, hearing voices are regarded as spiritual rather than disordered.
Altogether, then, although psychiatric diagnosis is based on the medical model of
diagnosis, it may not be compatible with this paradigm so long as reliability and validity are low.
Instead, psychologists argue for a ‘complaint-based’ approach, which involves exploring and
treating specific difficulties, linking them not to diagnostic categories but to other thoughts,
190051753 PSM611 3
feelings, relationships and experiences. Therefore, tying symptoms not to a broader label but to
context.
Working with the individual in context favours a model of formulation, which involves
devising tentative hypotheses about an individual’s difficulties based on psychological theory.
Formulation, therefore, advocates collaborative exploration of the unique experiences and
personal meaning that individuals attribute to their distress. This principle, therefore, fits within
the ethos of counselling psychology. By dealing with subjective experience, psychologists can
work holistically to map out the links between clients’ thoughts, feelings, behaviours and
relationships without making assumptions.
Although formulation may not provide immediate relief as might a diagnostic label, it
replaces medical jargon with understandable language and promotes client agency in exploring
their unique experiences of distress. Formulation also explores clients’ strengths, a value
espoused by the humanistic value base of counselling psychology. However, its subjective
nature does not prevent social and cultural factors from influencing psychological practice;
moreover, replacing diagnostic systems with a formulation-based approach would be a huge,
costly change. Therefore, some professionals advocate diagnosis for a broad understanding of an
individual’s difficulties coupled with a formulation of their specific difficulties.
In summary, in counselling psychology, the scientist-practitioner model represents the
creative tension between exploring clients’ subjective experiences and drawing on objective
sources for diagnosis. Ultimately, the current model of diagnosis, using the DSM, is flawed on
this account: it is spoiled by subjectivity. Instead, formulation – or both, combined – may offer a
more holistic account of an individual’s unique experiences and their personal meaning.

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Running head: 190051753 PSM611 1

Reflecting on how Diagnosis Interfaces with the Ethos of Counselling Psychology

Word count: 820

In counselling psychology, the psychologist actively consumes and contributes to

objective, scientific research; meanwhile, the counsellor’s therapeutic practice is underscored by

clinically assessed using psychiatric diagnosis.

Diagnosis is an established way of separating distinct forms of distress into individual

bodily complaints to a meaningful pattern of empirically supported symptoms to ensure correct

treatment and from which to make predictions about outcome.

Altogether, then, although psychiatric diagnosis is based on the medical model of

devising tentative hypotheses about an individual’s difficulties based on psychological theory.

Formulation, therefore, advocates collaborative exploration of the unique experiences and

relationships without making assumptions.

moreover, replacing diagnostic systems with a formulation-based approach would be a huge,

individual’s difficulties coupled with a formulation of their specific difficulties.

In summary, in counselling psychology, the scientist-practitioner model represents the

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