09 Mar 2018

BY: Anna Keyter

Assessment / Treatment

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Why a critical perspective on Scientist-practitioner Model?

With the DSM 5 changes, there is a renewed international reflection on the scientist-practitioner model also known as the medical model.   Mental and medical health professionals, as well as researchers, are familiar with the scientist-practitioner concept.  This article will take a moment to reflect on the true meaning of the scientist-practitioner in counselling.

Bury & Maise Strause (1) question the scientist-practitioner approach in the following ways:

  1. As scientist-practitioners, is our purported allegiance to, and reliance upon, ‘official’ sources of knowledge (including theory and scientific evidence) sufficient for us to be confident that we can construct consistently helpful solutions from the myriad clinical data at our fingertips?
  2. Should we as psychologists accept that full understanding of causality is simply not an achievable objective?
  3. If we adopt the position that we can never fully explain causes, however, what role do we actually play?
  4. Can our interventions even be considered valid, let alone scientific?
Corrie and Callanan (2) specifically reviewed the ‘evidence-based’ scientist-practitioner model.  Evidence-based practices suggest that clinical judgements are made based on researched treatments. Therapists are encouraged to base therapeutic decision-making on research rather than experience.  It is therefore important to clearly articulate the framework of professional activity to inform counselling professionals.   They feel that a major concern is that the scientist-practitioner model is outdated and largely based on a positivist philosophy of science. Positivism refers to an evidence-based reality that can be mathematically/objectively interpreted (read more about positivism here).
How do Scientist-Practitioner models influence professionals focussing on the Phenomenological and Humanistic approaches?
Clinical Psychologists have for many years worked within the medical model framework.  In certain instances, a clinical diagnosis is necessary especially when working with mental illnesses such as schizophrenia or serious pathological conditions.   For other mental health professionals, having to come to terms with prescribing treatments within the DSM diagnostic framework, is new. Sometimes, a clinical diagnosis is a requirement for medical insurance pay-outs or to receive treatment assistance from National Health Care organisations.  Counsellors working from a humanistic perspective do not assume pathology, they have faith in their clients’ ability to work through problems.
 There are a number of criticisms of the DSM-5:
  • Excludes context information and culture,
  • Labelling though diagnosis,
  • Stigma after diagnosis.   Read more on DSM-5 here.
In conclusion, for practitioners working within a humanistic framework, it is a challenge to reconcile the medical model with their personal values.  The humanistic approach is non-pathological, believes in self-actualisation of clients and working towards an ideal self-view (Rank, Rogers, Maslow).
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References

(1)   Bury, D. & Strauss, S. M. (2006). The Scientist-Practitioner in a Counselling Psychology Setting. In: D. A. Lane & S. Corrie (Eds.), The Modern Scientist-Practitioner: A Guide to Practice in Psychology. (pp. 112-126). London, UK: Routledge. ISBN 1583918868

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