Fix versus Create: Why clients come to see you
In most clinical practices, clients come with a presenting problem that they either want the therapist to solve or because someone else has sent them to get ‘fixed.’ Psychotherapists see many of the latter in marital therapy and child therapy.
Applying the traditional medical model of therapy, the therapist would likely undertake the following strategies:
* Talk with the client about her personal and medical histories and previous mental health treatment.
* Explore the history and duration of the problem.
* Discuss why the client believes she might have this problem at this time in her life and continue to gather pertinent current and historical information.
* Consult the most recent DSM (Diagnostic and Statistical Manual of Mental Disorders) or the ICD (International Classifications of Diseases), give the client a diagnosis, and develop a treatment plan.
If the client has insurance, the diagnosis hopefully is one that the insurance company will accept. If not, the therapist faces the common dilemma of deciding whether to assign a DSM diagnosis that will enable the client to get insurance reimbursement. Many therapists will do this simply to enable the client to get reimbursement — not because the diagnosis is in any way helpful (with the exception of training in a clinical program setting). This situation is the sad reality of managed care and the rigid application of the medical model to the helping professions, which is mostly the case in the United States.
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