Medical Model in Psychotherapy Versus the Family Therapy Approach
Updated: Sep 28, 2019
At the center of the medical model in psychology lies the idea that there is such a thing as a statistically normal psychological functioning of the individual. If the person experiences any distress, there is a deviation from that “normality,” usually caused by combination of biological, psychological and social factors: “The symptoms in our diagnostic criteria are part of the relatively limited repertoire of human emotional responses to internal and external stresses that are generally maintained in a homeostatic balance without a disruption in normal functioning.” (APA, 2013, p. 733).
According to the model, effective treatment must start with an assessment to gather information, to find a specific problem or a combination of issues, to then identify the correct treatment. While Family Therapy models value assessment, these assessments can be seen as less rigid than the DSM V, both regarding the idea of absolute necessity, the timing and length of the assessments, and the strictness of protocol.
DSM V, or the Diagnostic Statistical Manual of the American Psychiatric Association, is the primary psychological diagnostic tool used in the United States, that follows the medical model. A quick review of the contributors shows that the contributors to the manual are either medical doctors, researchers with Ph.D. or both. The manual is a list of mental health conditions. Each mental health condition has a list of symptoms. When enough symptoms exist, the individual can be assigned a diagnosis from one or more of the categories. There are a few problems with that approach. One of them is seeing individuals as a separate system, outside of social context. Even though social effects are considered in the DSM, the expectation is that after the assessment is given, the person should be treated as an individual, usually on a biological level via medications.
Another problem with the DSM as a representation of the medical model is the rigidity of its’ categorical structure:
A growing body of scientific evidence favors dimensional concepts in the diagnosis of mental disorders. The limitations of a categorical approach to diagnosis include the failure to find zones of rarity between diagnoses (i.e., delineation of mental disorders from one another by natural boundaries), the need for intermediate categories like schizoaffective disorder, high rates of comorbidity, frequent not-otherwise-specified (NOS) diagnoses, relative lack of utility in furthering the identification of unique antecedent validators for most mental disorders, and lack of treatment specificity for the various diagnostic categories. (APA, 2013, p. 733).
Even though the more structured family therapy assessments are also usually done during the first session, like the constructing of a genogram to understand the complex structure of the family, unlike a DSM diagnosis, these assessments continue to evolve during the following therapy sessions. When the family members present new information, the genogram can then be updated. A genogram is a widely used assessment tool in family therapy since it allows to gather and visually represent a wide array of information about the family system: “Currently, genograms have become a basic and fundamental tool used to graphically represent a detailed record of family information. Their construction should include not only basic details and family structure but also information that can outline different approaches for both research and clinical intervention.” (Arias, 2017, p. 6).
As a family therapist, I understand that an assessment tool such a genogram will never be able to assess the complete picture of the family history, so it is just a tool for providing information. As such, there is no diagnosis at the end of it, and there are no strictly prescribed ways of treating the system. Besides, one might say that in family therapy pretty much everything that happens in the session is some assessment: From the place in the office where the family members choose to sit, to the way they talk. The full picture of the presenting problem gradually unfolds throughout psychotherapy. It is essential to understand that the family structure and the relationships between the family members and their interactions never stay the same: They continue to be affected by the internal and external forces, one of them being the therapist and the course of therapy itself.
To conclude, family therapists make a unique contribution to the provision of mental/emotional healthcare. They always look at individuals as parts of larger systems, and they assess both the family system and its components and sub-groups while understanding that their assessment never ends and that their assessment is not more than a continuously changing map.
Sasha Raskin, MA, is an international #1 bestselling co-author , the founder and CEO of Go New , a transformational education program, a life, and business coach and a psychotherapist in Boulder, CO. He is working on a P.h.D in Counseling Education and Supervision and is an adjunct faculty at the Contemplative Counseling master’s program at Naropa University, from which he also graduated. Sasha has been in the mental health field for more than 10 years, worked with youth at risk, recovery, mental health hospitals, and coached individuals, couples, families, startups, and groups. He has created mindfulness stress reduction and music therapy programs within different organizations. Whether it’s in person or via phone/video calls, Sasha uses cutting-edge, research-based techniques to help his clients around the world to thrive.
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Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Arlington, VA: American Psychiatric Association.
Arias, J. C. (2017). Genogram: Tool for exploring and improving biomedical and psychological research. International Journal Of Psychological Research, 10(2), 6-7. doi:10.21500/20112084.3177