The medical model assumes that we as therapists are the experts. Meaning that we know best in understanding and explaining what is happening to a client. Therefore only we can name those challenges by giving a correct diagnosis – a client needs us if they want to find the ‘right’ way of getting better. We as therapists are the holders of truth.

The medical model assumes that the therapist can be pure, unbiased and unicumbered by incorrect information.

Correct diagnosis is key, as that will dictate which intervention to pursue.

Is that assumption correct though, are therapists a bastion of accuracy when it comes to finding a correct diagnosis?

A mentor yesterday told me there is research suggesting that even when attempting to diagnose depression, only 65% of therapists we’re correct…

…That’s not a great accuracy rate for a mental health challenge we come across so very often.

Findings like that don’t exactly feel me with confidence when it comes to our truth finding abilities. My confidence in the medical model continues to weaken.

This is why I gravitate towards the contextual model in therapy. This models assume that client outcomes are better explained by a therapist’s use of the common factors in therapy.

The contextual model also assumes that when explaining a client’s presenting challenges, truth is not required, only that the client accepts the explanation of why they are depressed, for example.

This model assumes that even if the truth is out there, we have no way yet of scientifically knowing if we have found it.

This makes the client matter so much more in therapy.

It encapsulates my obsession over the last 2 years in building my own therapeutic process that supercharges how I align with my client’s preferences.

In my mind, the more you align with a client’s therapy preferences, the more likely they are to find an explanation for their challenges that they can accept, which increases the odds of a better outcome from therapy.

So if you ask me, my ability to diagnose isn’t the key to good therapy

It’s my ability to align with my client’s preferences. Even more, it makes it part of my job to help clients find and explain their preferences – not put all my energy into figuring out a label.

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