The Medical Model

With my background in Psychotherapy, I do psychological work as part of my Philosophical Counselling. It is important to understand that this is different from doing clinical psychological work.

Our psychology is a dimension of our being which does not belong, so to speak, to any particular conceptualisation. Just as we can see our body through a range of different lenses, so too our psychology. Clinical psychology interprets our psychology according to a particular technocratic paradigm called "the medical model." This is the paradigm embodied by Psychiatry, Clinical Psychology, and clinical Social Work. It is the reason why those professions can access Medicare in Australia, while Counselling and Psychotherapy cannot, for the latter are not clinical professions. Counselling and Psychotherapy, at least as I am trained in them, do not operate according to the medical model, and while they recognise it has an important place, they are critical of its over-reach and its limitations. (N.B. criticism is different to rejection—in no way am I encouraging you to abandon clinical support if you need it.)

The clinical professions and the non-clinical ones are fundamentally different in their self-understanding and their practices. With regard to Psychotherapy, I work in the ways described in the previous section: phenomenologically, while also drawing on tools from other psychotherapeutic paradigms such as Psychodynamic Therapy. I am not a clinical professional. I cannot, and do not, provide clinical mental health assessments, diagnoses, treatments, management, reports, letters, or advocacy. At the same time, I am not offering mainstream Counselling or Psychotherapy, rather I integrate them into something else: Philosophical Counselling. If you need clinical mental health services, you will not get them from me, but neither will you find a substitute here; what I do is different.

I help people with any concern that Philosophical Counselling might beneficially address. That may include concerns that a clinical professional might diagnose, or has already diagnosed, as a mental health disorder. For instance, a person may suffer from one of those rarer (about 10% of cases?) forms of depression that is largely organic in origin—in popular terms, caused by brain chemistry. Such a depression calls for clinical assessment and treatment. But that person may also benefit from Philosophical Counselling, because there is more to a person, and often more to their struggles, than their disorder, even when it is organic in cause. Their depression affects other aspects of their life. And there are feedback loops: as I say below, a human being is a centre of intelligent consciousness woven into an animal life of bodily and psychological forces, and we can shape those forces, but they also shape us--they can hinder, blind, or distort our vision. So a client with an organic depression may still need to do reparative or creative work at the level of intellect and will and phenomenological therapy—for example on how they see themselves, and on how they think understand and respond to their suffering. Helping with such work is not the same as providing clinical treatment for the disorder. 

It should also be noted that many challenges framed as clinical disorders are, in reality, deeply contested. For example, deep grief is increasingly pathologised, and many helping professionals disagree with that. Also, many researchers assert that the majority of cases of depression are "reactive"—responses to life experiences rather than biological illnesses—and some professionals argue that they should be understood in Humanistic or existential terms rather than clinical ones. As a practitioner in a society dominated by the medical model, I cannot engage publicly with these controversies without risk of unfair litigation, so I leave that debate to academics and non-practitioners. Suffice to say that whether a given challenge is best seen as a clinical disorder or as an expression of the human condition that is to be met through insight, growth, wisdom, and virtue, is very often an open and contested question. I acknowledge the validity of the clinical paradigm within its proper domain, which concerns genuinely clinical problems, as well as problems that may be helpfully addressed by clinical work even when they can also be seen and responded to in other ways. And I advise anyone who suspects they need clinical help to seek it. I assert also that the clinical paradigm has its limitations, like everything else in life, and that as a society we need to be wise about that, and to avoid reducing ourselves to technocratic concepts.