Counselling the (self?) diagnosed client: generative and reflective conversations

Abstract

In this paper, we address the phenomenon of clients who present their concerns in the medicalised discourse of the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5). We contextualise this phenomenon, highlighting how a ‘diagnose-and-treat’ logic increasingly pervades everyday understandings and informs people's efforts to make sense of their concerns. We relate these cultural ways of sense-making to discursive counselling practice, noting possibilities for circumventing ‘discursive capture’ through reflective and generative dialogues. We then turn to two common ways in which clients present their concerns in counselling: (1) arriving self-diagnosed or diagnosed by another professional and (2) as a family in which parents present a child as having a mental disorder. We suggest ways of moving beyond medicalised discourse via resourceful and critically reflective conversations with clients.

Keywords:

• counselling psychology
• medicalisation
• diagnosis
• narrative therapy
• family

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Tom Strong is a professor and counsellor-educator at the University of Calgary who researches and writes on the collaborative, critically informed and practical potentials of discursive approaches to psychotherapy. He is co-author (with Andy Lock) of Discursive perspectives on therapeutic practice (Oxford University Press) and Social constructionism: Sources and stirrings in theory and practice (Cambridge University Press). For more details on Tom and his research please consult: http://www.ucalgary.ca/strongt/

Karen H. Ross is a doctoral student at the University of Calgary and narrative-collaborative therapist interested in how different discourses of ‘mental health’ shape options for problem-solving and identity construction, particularly among young people. For more details on Karen and her research interests please consult: http://www.ucalgary.ca/strongt/node/50

Monica Sesma-Vazquez is a collaborative and social constructionist practitioner (mostly in therapeutic and educational spaces), currently doing a postdoctoral fellowship at University of Calgary. She is a Taos Institute Associate, a Grupo Campos Eliseos professor and the Spanish Translator Editor for the International Journal of Collaborative Practices. For more details on Monica and her research projects please consult: http://werklund.ucalgary.ca/profiles/monica-sesma-vazquez

Additional information

Funding

This work was supported by the Social Sciences and Humanities Research Council of Canada [grant number 435-2012-0674]; Werklund School of Education.