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The medical model of psychotherapy is an approach according to which the disorder is caused by the action of an internal, intrapsychic factor (or several internal factors), and psychotherapy is possible only if the client is freed from the pathogenic influence of this internal (deep) circumstance.
In Russian: until you find an internal problem, do not get rid of your splinter, you will not have anything good.
How doctors see the disease
For physicians, the cause of the disease is the action of one or two internal pathogenic factors. For example, it’s a virus. Viruses cause symptoms: red throat, skin rash and fever. To eliminate the symptoms and restore health, it is necessary to diagnose the pathogenic factors and offer a treatment that will stop them, and then restore health.
For example, a patient reports that he has been having problems for two weeks now: nothing pleases him, loss of interest in previously interesting activities, fatigue, lethargy, lack of appetite, significant weight change, thoughts of death or suicide, difficulty concentrating, feelings of hopelessness, guilt and / or low value. The psychiatrist examining this patient may conclude that this symptom complex meets the DSM-IV criteria for a major depressive episode. Based on the assumption that the major depressive episode is caused by intrinsic neurochemical and neuroendocrine abnormalities, the psychiatrist will most likely prescribe the appropriate medication…
Medical model in the field of psychotherapy
And how will not a psychiatrist, but a psychotherapist behave in this situation? Unlike the psychiatrist, the psychotherapist will carefully question our depressed patient about recent troubles or major losses in childhood. The psychotherapist believes that the patient’s painful experiences due to his breakup with a friend are related to painful experiences in childhood, for example, due to the divorce of parents or lack of motherly love. The therapist will ask the patient in this direction, and if the client remembers something like this, he will be convinced together with him that this is precisely the point. If the patient experiences this understanding as an insight, he will relieve his anxiety about his own depression, perceiving it as completely natural, but, on the other hand, in the future it will be better to control his emotional reactions.
So, in principle, the approach here is the same, the only difference is that the psychotherapist looks for and finds other pathogenic factors: for example, psychotrauma in early childhood, unconscious motivations, pathological development of the Self, fixations of psychosexual development, unconscious psychological defense mechanisms and disturbed object relations …
Remember traditional psychoanalytic and psychodynamic explanations of psychopathological processes and see →
A critical look at the medical model in psychotherapy
Representatives of the behavioral approach to this approach have many complaints. The main ones are:
- Incorrectness of the general diagnostic approach.
The belief that people cannot cope with their disorders has no scientific basis, and those who are inclined to such views simply tend to see people as rather helpless, less amenable to natural self-healing. In addition, disorders can be caused not by internal, especially not by deep factors, but by a variety of external and everyday circumstances. See Neck hurts: who finds the cause in what
- The main assumptions on which this model is based are:
a) intrapsychic factors (subject to their adequate operational definition and measurement) affect the frequency of occurrence
problem behavior,
b) insight causes an adaptive change in behavior and
c) modification of behavior without affecting the underlying causes will eventually result in the return of symptoms.
have no evidence base. There are no serious studies to prove this.
- Tautological, taken «from the ceiling» explanations of personality disorders. We invent what might cause a personality or behavioral disorder, and we take it as evidence that we are seeing that disorder. Type:
Question. Why is this person drinking water? (Observed behavior.)
Answer. Because he is thirsty. (An unobservable intrapsychic state cited as an explanation.)
Question. How do you know he’s thirsty?
Answer. Because he drinks.
More complex behavioral problems are explained in the same vicious circle manner. Possible explanation for nocturnal enuresis:
Parent Question: Why does my daughter wet the bed?
Therapist’s answer: Because she is afraid of her parents’ impending divorce and is unconsciously trying to get emotional support by regressing to earlier stages of development.
Parent Question: How do you know that she is unconsciously trying to get emotional support through regression?
Therapist response: Because she wets the bed.
Possible explanation for self-injurious behavior:
Observation: A mentally ill person in a hospital constantly beats his head against the wall, resulting in retinal detachment and possible blindness.
Physician’s explanation: I think the patient may have witnessed a traumatic event while he was a child.
This behavior is an unconscious attempt, through blindness, to make it look like he never saw the event.
Behaviorist question: What evidence do you have to support this hypothesis?
Physician’s answer: Headbanging and theory.
What instead of a medical model?
It is not necessary to imagine a person as a weak being, a victim of deep processes. The personal-active approach considers human behavior both as a result of learning and as its author’s work. Accordingly, erroneous behavior is the result of inadequate learning, and a person simply needs to be retrained. A person can simply retrain himself. In addition, if a person is not inclined to the position of the victim and chooses the position of the author, then he takes responsibility for his behavior, does not attribute everything to underlying problems and pathogenic factors, but builds his life as an adult and reasonable person. See →
references
- Psychological Encyclopedia