tag:blogger.com,1999:blog-929120080777377869.post7445002493555048156..comments2024-02-19T02:33:16.495-08:00Comments on Psychodiagnosticator: Diagnosis vs. Formulation: A False Opposition?Huwtubehttp://www.blogger.com/profile/11269941937374416664noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-929120080777377869.post-21684013168174513132016-03-04T12:21:15.574-08:002016-03-04T12:21:15.574-08:00Beautifully written.Beautifully written.Dr. Morbidhttps://www.blogger.com/profile/15609000002797039991noreply@blogger.comtag:blogger.com,1999:blog-929120080777377869.post-42387621550748120672013-04-24T13:57:31.399-07:002013-04-24T13:57:31.399-07:00Hi uilleannair, nice point, and it is well taken. ...Hi uilleannair, nice point, and it is well taken. Psychiatric diagnosis is taken, by many professionals and service users, to be *true* in some deep ontological sense. <br /><br />However, whatever the common practice of diagnosis, this implication isn't inherent to it. I am being taught to use the DSM at the moment because in the US one needs a diagnosis for insurance purposes. Believe me it's very jarring, not only to me but to all my colleagues. However, we are being specifically taught to regard the label not as some ontological category, but as a "snapshot" of the person's problems at a particular point in time. <br /><br />It is not clear to me how much this goes against the officially stated purpose/vision of the DSM, but the APA openly acknowledges the consensual manner in which it devises its categories. This seems to suggest that even many of the DSM's designers are able to view it as an imperfect work in progress.<br /><br />My main point however, is not necessarily that the DSM is compatible with formulation, but that the concept of diagnosis per se need not be thought of as separate and opposed to formulation . If a nominal diagnosis can be derived from the distillation of a longer formulation (as in the examples I use in the post) then there is no reason why these two things can't be considered to have the same ontological status as one another. Huwtubehttps://www.blogger.com/profile/11269941937374416664noreply@blogger.comtag:blogger.com,1999:blog-929120080777377869.post-47761011053760214042013-04-24T02:44:22.110-07:002013-04-24T02:44:22.110-07:00Good post. I wonder, though, if you’re missing an ...Good post. I wonder, though, if you’re missing an important difference between a formulation and a diagnosis (in the “medical” sense), to do with truth claims. A medical diagnosis purports to be *true* in the sense that it is based on a realist epistemology. It assumes that there is a real, actual, existing-independently-in-the-world causal story about the aetiology of someone’s symptoms and that it’s possible to know what this is. <br /><br />I don’t think many proponents of formulation would claim to be making that kind of statement. Rather, a formulation is a *way of thinking* about someone’s problems, that is valid insofar as it helps the clinician AND the client make sense of them. It is not meant to be a claim about truth in the direct realist sense. That’s not to say that all proponents of formulation are relativists (although I know that some are), simply that a formulation isn’t understood as a statement of fact in the way that a medical diagnosis is usually intended to be. This means that there are at least as many possible formulations of a given person’s difficulties as there are models of therapy, or even as there are therapists. And that’s not, per se, a problem. <br /><br />For me, this was the take-home point from the Johnstone and Dallos book, in which a range of clinicians from different orientations offer formulations of the same two cases. There’s no attempt to establish which formulation is best, most correct, most accurate or whatever. In the absence of a real interaction with the client there would be no basis on which to do that, since the validity of a formulation is in its clinical utility not its truthiness.<br />uilleannairhttps://www.blogger.com/profile/17031972524883239786noreply@blogger.com