Posted at 12.12.2018
The challenges of diagnosis and assessment are key to the treating psychological disorders. There are always a many issues raised by assessment, and its own application. Many counsellors hire a number of different methods, such as pre-counselling interviews, intake questionnaires or diagnostic testing. Counsellors may also consider assessment according with their own theoretical model or counselling approach.
Clinical assessment is the process of evaluating and measuring psychological, biological, and social factors in an individual presenting with a possible mental disorder. Information and data gathered from examinations, interviews, assessments and health background are evaluated, and an assessment, then prognosis and treatment can be formulated.
For counsellors and other allied health professionals, there are a number of diagnostic models available, that often take into account different counselling theories and approaches. For the purpose of this assessment, the diagnostic medical model will be discussed compared to a diagnostic biopsychosocial model, and their uses in working with mental medical issues.
Diagnosis is the process of determining whether the particular problem affecting the individual meets all standards for a psychological disorder (American Psychiatric Association, 2000). The medical model is based on a couple of norms that views behavioural abnormalities in the same framework as physical disease or abnormalities. An assessment using the medical model may contain interviews, and behavioural assessment and testing, such as personality inventories or intelligence tests
It deals primarily with medical diagnoses: DSM-IV is the latest incarnation of the "Diagnostic and Statistical Manual" produced to assist to make clear, correct, and reliable diagnoses, and promote more accurate understanding of mental disorders (Barlow & Durand, 2008).
One of the very most useful and valuable functions of the DSM-IV is that is provides a framework for clinical practice, a system of naming and describing mental disorders. This common framework not only provides shared terms allowing easy information sharing and use of research among mental health professionals, but also facilitates sharing of diagnoses with clients and other practioners, and simplifies the recording and dissemination of records and cases.
The DSM-IV also assists mental health professionals to anticipate the typical course of a problem and the client's symptoms, to support the introduction of treatment plans.
The DSM-IV classifies and mental disorders into divisions based on set criteria. This categorisation is the essential approach found in all systems of medical diagnosis (American Psychiatric Association, 2000). This model is most effective when all members of your set or class are uniform, whenever there are clear boundaries between classes, and when the various classes are mutually exclusive. Unfortunately, not all people present with standard symptoms or problems. Many mental disorders are not distinct disorders, but can look with others (for example, depression is often seen with other mental illnesses, and insomnia may be a symptom of something else, rather than final diagnosis). The DSM-IV also mirrors social attitudes about precisely what is defined as a mental disorders, and what they are made up of. Just considering the changes in the last few decades on the treating homosexuality by the DSM-IV, where it includes moved from being classed as a mental disorder, never to being included, heightens the idea these are guidelines, and really should be treated with responsibility, accountability and due care.
The DSM-IV useful in situations where a formal classification of mental health disorder may be needed, due to legislative or judicial requirements (Bernstein & Nash, 2006). For example, a kid may qualify for government financial assistance if a particular disorder is diagnosed by using a DSM-IV classification, or other diagnoses may mean that educational institutions or government agencies including the Public Trustee do something or use different processing criteria in dealing with clients. The acceptance of DSM-IV classifications by government agencies, insurance companies and medical institutions means there are normal backgrounds and settings, allowing smooth communication and interaction.
While acknowledging that the medical model is incredibly useful, it is not without its drawbacks. You can find the risk a relatively few instances can form attitudes and influence legislation. As previously mentioned, the DSM-IV is very culturalcentric, and it is very strongly predicated on disorders and conditions as they present in the united states, and westernised, first world countries, there might not be as relevant or useful in different countries, cultures or sub-cultures (Barlow & Durand, 2008).
As the medical model is very much concerned with labels and classification, it can also be very demoralising to be reduced to a label or to be pigeonholed, and can lead to negative perceptions by your client, and towards your client (Bernstein & Nash, 2006).
There is also the danger that the linear method of diagnosis can prevent a far more holistic and progressive understanding of your client. The categorising and classification of your client may also overemphasise, and concentrate on the client, rather than on the family or social system, where the challenge or resolution might be (Barlow & Durand, 2008).
The diagnostic medical model is based on deficiencies and negative comparisons on track mental functioning, rather than identifying positive attributes, traits or factors. It involves assessments by third parties who usually do not know your client very well, but take a look at and quantify the client's departure from typical, and can be responsible for many negative connotations.
It has also been suggested that modern medical thought was governed by the perception that human body and mind can be treated by introducing chemical substances in to the mechanical system of the body, and by fixing or replacing parts. This thinking excluded the psychological and spiritual facet of treating humans, and considered biological factors of primary importance overlooking factors as the patient's psychological, culture or social environment (Hewa & Hetherington, 1995)
It is this exclusion that led George Engel propose a more inclusive, alternative model, also to include a sociocultural and psychological framework to the limited biological framework of the medical model. This model assumes that psychological and social factors must be included combined with the biological to gain a genuine understanding a person's medical illness or disorder (Bernstein & Nash, 2006).
It is quite an integrative and comprehensive model which allows us to give attention to the presenting issue across three spheres: physical, psychological, and sociocultural. Proposed by Engel in the 1979's, it allows and encourages medical researchers to holistically examine the interactive and reciprocal effects of environment, genetics, and behaviour (Engel, 1977).
As an alternative solution to the medical model, this approach is used not merely as a diagnostic system, like the DSM-IV, but as a tool to gather data to get information about your client and their environment, to aid the look of successful treatment (Cormier, Nurius, & Osborn, 2008, p. 1760).
Instead of simply a breakdown of symptoms, or reports by treating professional or third parties, more unclassified or unquantifiable factors can be taken into consideration; individual responsibility or personal determination can be viewed as, or particular outlooks and insights can highlight emotional difficulties and strengths, allow alternative and personalised treatment. In assisting clients coping with gambling or drug addiction, this could be an absolute advantage. A client's behaviour, their mood and thought processes is a significant influence in the success or failure of any treatment solution (Engel, 1977).
Attention is paid to what sort of client functions in everyday life, how they manage social roles, emotional stability, intellectual capacity and overall well-being (Bernstein & Nash, 2006).
This model also acknowledges the importance of social areas, including family systems, diversity, and social justice (Kaplan, 2005). Assessment that includes a knowledge of support structures such as friends, family or advocates, and access to medical care or continued case management, is similar to to produce lasting, positive results.
Treatment wise, the biopsychosocial model appears to be an even more holistic approach, and better suited to help the complete person, rather than simply focusing on a particular disorder.
Drawbacks to this module may be that it's very subjective and individual, making its use more difficult for organisations that are funded or staffed predicated on the classification of these clientele. This model would also consume much more of an counsellor's time as the medical model, again rendering it less affordable, especially for government or not-for-profit organisations. The average person and personal nature of the model makes its funding and resourcing much more difficult than a lot more general medical model (Bernstein & Nash, 2006). Overall, it seems to be a more positive model, resulting in greater results. Both models presume that trained professionals will be using these assessment tools, and both models won't function well if not used in combination with appropriate training and attention. In the short term, the medical model would be cheaper to fund, but long-term the biopsychosocial model should produce longer lasting and better outcomes (Engel, 1977).
Assessment is the systematic analysis and measurement of psychological, biological, and social factors within an individual (Barlow & Durand, 2008). Diagnosis is the process of identifying that those factors meet all the requirements for a particular psychological disorder. The subsequent step, to consider how this information be used to assist people to live rich and meaningful lives, is where in fact the biopsychosocial model is able to provide more material and information to assist clients and mental health workers.
The aim of counselling is to be of help and assist with the client, to aid in living better lives, coping with various situations, and develop and progress as humans. Categorising and classifying disorders does make life easier for an assessment, but every situation is different, and every client is unique and individual.
It not necessarily a one size fits all treatment. An excellent counsellor should think about the question presented by Gordon Paul - "What treatment, by whom, is most effective for this individual your specific problem and under which group of circumstances?" (Kaplan, 2005, p. 1). Counselling takes a comprehensive inclusive model that allows assessment and intervention over the variety of methods and approaches.
A sound diagnosis is a starting place for a treatment plan, not necessarily a finish to itself. The DSM-IV is indispensable in providing a common framework for practioners and researchers. However, it's the start of the process, which is also in a constant state of change as ideas change, research continues, and our knowledge of mental health disorders increases.
The more that a problem can be understood, a far more reliable and helpful action can be planned. The more holistic biopsychosocial model, taking into account more regions of the client's life, environment and spheres, provides a clearer picture of the client's circumstances, and any mechanisms that are available to help the client handle problems and difficult situations.
For the person-centred counselling approach, the attitude towards assessment, diagnosis and treatment are seen as compromising "genuineness" - a simple element of the person-centred approach.
To the Rogerian perspective, how the client is assessed by the counsellor is not as important as your client assesses themselves. "The opportunities for new learning are maximised when we approach the individual without a preconceived set of categories which we expect him to fit" (Rogers, 1965, p. 497). The client is the one with the actual to learn, understand, and change their feelings and behaviours, and to harness support networks to change themselves.
According to Rogers, diagnosis in itself could be unwise, as the focus of assessment shifts to the counsellor as an expert, dependent tendencies may develop. Considerations of such a nature have led person-centred therapists to minimise the diagnostic process as a basis for therapy (Cormier, Nurius, & Osborn, 2008).
This is reflected by Egan, with the statement that "assessment, then, is not at all something helpers do to clientsRather, it is some sort of learning in which, ideally, both client and helper participate" (Egan, 2007)
In keeping with the need for greater client involvement, humanistic oriented counsellors often employ more qualitative (how and just why) methods of assessment where the client participates actively in learning/assessment exercises built-into the counselling sessions themselves, rather than the more quantifiable (what and when) assessment from the medical model and the DSM-IV.
The model's inclusive, multi-factorial or holistic advantages create the possibility of an approach to mental health issues, which could be both scientific and humanistic.
As a diagnostic tool for helping people with mental disorders, the biopsychosocial model would be suited when compared to a strict medical model even as understand that mental illness arises from more than biological factors, look at body, mind, spirit, relationships and environment, in treating a human individual, not merely treating a sickness.
As George Engel wrote;" nothing changes unless or until those who control resources have wisdom to venture from the beaten path of exclusive reliance on biomedicine as the only approach to health care'' (Engel, 1977, p. 135)