I will not attempt to repeat the content of Rachel’s presentation because the excellent 5 page hand-out, ‘Key features of the medical model framework,’ is available to you. Just ask for it by emailing [email protected].  Also Rachel has written a scholarly book on the subject: ‘Psychiatry and Mental Health. A guide for counsellors and psychotherapists’ (PCCS Books, published 2020). 

In the workshop, Rachel described what the medical model is. This is her definition: ‘a conceptual framework to explain pathology, and a particular method of helping, couched in a certain type of language, underpinned by a range of values, particularly those of modern science.’

Over the day, we looked at the implications of this model for psychiatrists, patients, and counsellors.

Rachels’ personal story is very interesting. She found that working within the medical model (M.M.)  and NHS framework became too limiting for her after 25 years as a psychiatrist, and she recently quit psychiatry to become a person-centred counsellor in private practice.  She told us that doing so felt like she had ‘shed a very tight skin.’

It is not the case however that she sees the M.M. as ‘all bad’ and we explored the positives and negatives of the model.

For example, rootedness in science and evidence has many benefits, and almost of all of us see the value of appropriate medication, and even psychiatric labels can have value too.  The negatives are pretty familiar also to most of us in the counselling world – the inability of the M.M to address the ‘whole person’ or to focus on growth, and a focus on fixing or curing rather than addressing underlying patterns and trauma.

Rachel is keen for the M.M and the ‘holistic model’ to have mutual respect and learn from each other.  She is unusual in having a foot in both worlds and seeks a dialogue between the two models. She sees the importance of relationship between therapist and client as a crucial healing element in the counselling world, and for many reasons (including lack of time available) this relational element is often lacking or weak in M.M contexts. She says we counsellors and psychotherapists should have more self respect about the way we work, especially when dealing with doctors and psychiatrists.

The M.M. can be seen as a reflection of our wider culture where experts and technology and measurement are valued. Perhaps these attitudes are slowly changing though.  More and more the M.M is working with other approaches. What used to be thought of as quackery may now be seen as complementary approaches. Hypnotherapy and C.B.T, for example, are seen as useful methodologies on the basis of evidence of results.

Towards the end of the day, Rachel touched on new frameworks to discuss mental ‘disorder’ that are emerging such as the ‘Power-Threat-Meaning-Framework’ being developed by psychologists. According to its authors, ‘mental health diagnoses are not verifiable in the way physical health diagnoses are; and diagnosis brings shame and robs people of the opportunity to make their own meaning.’

https://www.bps.org.uk/power-threat-meaning-framework

This sounds like a future possible training day topic for hacp!

All in all, it was an excellent and challenging day led by a really knowledgeable and thoughtful expert, and some feedback by participant talked of the day being ‘empowering’ and ‘enlightening.’

David Brown

Further reading suggested by Rachel:

Doctoring the Mind.  Why psychiatric treatments fail.  Bentall.  Allen Lane / Penguin Books.  2009

Madness Contested: Power and Practice.  Edited by Coles, Keenan and Diamond.  PCCS Books.  2013

De-medicalizing Misery.  Psychiatry, psychology and the human condition.  Edited by Rapley, Moncrieff and Dillon.  Palgrave Macmillan.  2011

Humanising Psychiatry.  The challenge of the person-centred approach.   Freeth.  Radcliffe Publishing. 2007.

Cracked.  Why psychiatry is doing more harm than good.  James Davies.  Icon Books. 2013

Drop the Disorder. Challenging the culture of psychiatric diagnosis. Edited by Jo Watson. PCCS Books. 2019