University

12/06/2010

Psychiatry and clinical psychology have failed. Here's how we do better.

DSM 4 This has been a bad week for mental illness.

According to the New York Times, five of the current ten “personality disorders” will not be included in the next publication of the Diagnostic and Statistical Manual of Mental Disorders.  The most controversial to be cut is “Narcissistic Personality Disorder” – the “Malady of Me” disease!

So if you’re suffering from those conditions, don’t worry – in 2013 they’ll cease to exist. 

In the meantime millions of people have been diagnosed with Narcissistic Personality Disorder and the other personality disorders that will soon become extinct. They have been medicated, treated in psychiatric hospitals, received psychotherapy and have permanent records stating their psychiatric diagnosis. They have been stigmatized, charged money in the form of co-payments and out of pocket medical expenses, and experienced deep personal pain and shame – only to find that their diagnosis was a “pseudo-diagnosis” and no longer exists.

Truly, this is malpractice and professional negligence.  Even worse:  there is no known cause of any of the ten personality disorders, and never has been.  The gurus at the American Psychiatric Association hypothesize that the personality disorders come from a mix of genetic and environmental factors – but it’s hard not to be be incredulous when five of ten personality disorders are vanishing.

It’s not just personality disorders, either:  another New York Times article last week points out that the cost of residential eating disorder programs can run $30,000 dollars a month – with many patients needing three or more months of treatment. The kicker:  most insurance companies will not cover long term treatment because the inadequate empirical evidence of effective treatment remedies is inadequate. 

We don’t know how to fix an eating disorder, but we’re going to charge you $30,000 a month for trying.  We claim to understand personality disorders, but there could be five, or 10, or none:  the evidence is unclear. 

It’s time to call it like it is:  mainstream psychiatry and clinical psychology are failing. 

Current mainstream treatments are not cost effective and are not working in the long-term.  Diagnostic labeling is destructive, inaccurate and clinically cumbersome.

Clinical psychology is at a crossroads. Communities, families, schools and individuals are ailing and undeniably need its presence – but it has to transform into something better than a pseudo-quantitative pretension that psychology must be biological even if we don’t know how. 

Fortunately, there are better modals.  Humanistic psychology, psychodynamically driven, isn’t a quick fix, but it does live up to its promises. 

One such model is the “Client as Self-Healer” model, proposed by Art Bohart and Karen Tallman in their book How Clients Make Therapy Work.  Bohart and Tallman’s approach, rooted in humanistic principles, directly contradicts the medical model of psychotherapy treatment and has been empirically validated through quantitative and qualitative research.

The Client-as-Self-Healer-Model emphasizes a person’s creative self-healing capacities and resources for problem resolution and change in the context of psychotherapy treatment.  We all have the capacity to solve our own psychological problems, and most of the time we do – we are “self-healing.”  When that capacity for self-healing becomes blocked, stuck, or disabled ... then we turn to other people, including psychologists.  The symptoms and problems that people bring to the therapist’s office are the result of this blockage. 

Fromrom this perspective, therefore the work of therapy focuses in on a client’s abilities instead of disabling “diagnosable pathologies.” Ultimately, therapy becomes an environment where the client becomes energized and stimulated; thus engaging in a powerful personal meaning-making process.

The ultimate diagnostic criteria for Bohart and Tallman,then, is the client themselves.  That’s not something you can quantify in a Diagnostic and Statistical Manual, but it makes sense and it works. 

Based on the diagnostic failures and lack of scientific empiricism in psychiatric medication, psychology would do well to undergo a paradigm shift toward the humanistic perspective embodied in the Client-as-Self-Healer. The credibility of current psychological and psychiatric practice is diminishing and the public’s faith in both institutions is vacillating. Spring has come and the field is ripe for a humanistic revolution towards a strength-oriented perspective embodying the client as the ultimate source of healing.

-- Liz Schreiber

Posted at 08:42 AM in

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