Often when people go to see a counsellor; it is because they perceive that there is something wrong with them, something that makes them feel not quite right. Sometimes clients do not recognise for themselves that there is something wrong, and it is friends or family that draw their attention to it or advise them to seek help. With psychotic disorders individuals lose insight into themselves and are unaware that their behaviour may be deemed as bizarre or abnormal to an outsider.
There has been a history of disagreement even amongst professionals as to what might be deemed as abnormal. Psychiatrists tend to go with a symptoms, syndromes, diagnoses and treatment approach. Individuals are assessed along axes using the DSM scale. Psychologists would argue that you cannot have a cut-off point for such scales and illnesses should be thought of as being along dimensions.
Rather than thinking in terms of normal and abnormal, a person’s behaviour is sometimes viewed in terms of ‘mal adaptiveness’. Such an approach takes account of how well a person is able to cope with the demands of life and how well they have been able to adapt to their environment. This approach has been criticised for assuming that adaptation to the environment is necessarily a desirable outcome. It could be argued that a client who remains in a verbally and physically abusive relationship has made an unhealthy environmental adaptation.
Categorical systems have been criticised for being too a theoretical, being based largely on subjective experiences, and for being too classificatory. Despite the limitations of such diagnostic systems, they do serve as a point of reference between professionals and do provide an indication as to the severity and prognosis of a particular condition. It is useful for the counsellor or therapist to understand diagnostic types of techniques when writing reports for courts or if working in an acute psychiatric setting. Diagnoses can be useful where a client is prescribed medication through a GP or psychiatrist to enable them to gain some ‘inner space’ and energy before undergoing therapy from a psychologist or counsellor.
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