Assessment and diagnosis

Model of Psychotherapy

This chapter will explore the Waverley Model’s theory of psychotherapy. Rather than drawing distinctions between these terms, ‘psychotherapy’ and ‘counselling’ will be used interchangeably. In this context ‘model of psychotherapy’ refers to the therapeutic process. Focus is especially upon what elements are necessary in order to foster positive change (which we’ll examine in the first three sections of this chapter) and how the Holy Spirit’s involvement may be understood (which we’ll explore in next two sections). Additionally, it will be discussed as to how Christian counselling, if rooted in a wisdom Christology approach, will at times agree with and at others differ from secular approaches (see the last three sections of this chapter).

These issues emerge from the ideas set forth in the previous chapters, as an approach to treating problems needs to cohere with particular assumptions inherent within its personality theory and which sets the frame of reference for the conception and articulation of a problem.

Assessment and diagnosis

From the perspective of the Waverley Model, the counselling process is divided into three phases – exploration, diagnosis and resolution. This is defended on the grounds that ‘most agree with this strategy’ despite many different approaches being available to accomplish it. However, some maintain this is an overstatement: an approach which includes an ‘assessment’ or ‘diagnosis’ is antithetical to more humanistically oriented traditions of therapy. Not only is diagnosis regarded as unwarranted but also

as actively detrimental to client wellbeing. Rogers believed that the agents of positive change reside largely within an individual and would emerge when pain is reduced, not when an ‘accurate diagnosis’ is offered. Joyce and Sills acknowledge the unhelpful nature of adopting an ‘objective’ expert stance in formal diagnosis – it implies people are fixed/static; it can depersonalise the uniqueness of a client; it can make the therapist appear superior and so can foster undue reliance on ‘the expert’. However, they also assert that, ‘We are always assessing (‘diagnosing’) in so far as that all humans are meaning-makers. Our way of making sense of the world can be said to be an ongoing form of assessment or diagnosis.’171 This perspective views diagnosis as a continuous facet of relating in counselling (and life in general) and not a formal procedure to be carried out at a particular point or stage in the process. Other major therapeutic traditions wholeheartedly embrace diagnosis as a distinct and positive procedure. Beck, the founder of cognitive therapy, regards it as essential unless a previous diagnosis has already been carried out. Contemporary cognitive theorists also share the same view. More generally, Neenan and Palmer assert that any problem-solving psycho-educational approach to helping people is likely to endorse ‘diagnosis’ (although other similar descriptive terms may be used, like case conceptualisation, formulation, definition of the problem) as a specific procedure related to a ‘stage’ in their work with clients. From a Christian perspective, Shields and Bredfelt’s helping model, which they claim can be used broadly by pastors, Christian laypersons, teachers, those involved in discipleship and those who want to help a friend, also takes diagnosis (the word they use is ‘problem definition’) as a set phase of the counselling process.

Whatever differing philosophical position or method of assessing/ diagnosing we adopt, Palmer and McMahon’s argument regarding its pragmatic necessity is persuasive, rooted in the possibility that nonassessment could lead to the use of an approach that research shows has no value in helping a client’s specific problem. It is reasonable to assume that in therapy both parties implicitly suppose that the therapist has some relevant skills and/or insights (expertise) that make sense of why both agree

to work together, as opposed to a client turning to any other person for help. Regarding clients, Joyce and Sills state, ‘They came with the reasonable expectation that the counsellor has the expertise to help with the problem in as short a time as possible.’172 From a therapist’s perspective, there needs to be some rational justification for agreeing to work with specific clients (and their issues) in order to be operating within professional ethical boundaries which require both beneficence and non-maleficence.

It would appear that some form of diagnosis is inevitable, whether formal or informal, explicit or implicit, or as part of a ‘stage’/‘phase’ or as an ongoing aspect of relating. Having said this, it is quite clear that on the basis of Waverley Model Trainers’ Notes, their method sits clearly within the problem-solving oriented approaches, along with its subsequent benefits and potential problems. The problems, as noted above, may arise, not because of diagnosis as a principle or concept, but as a consequence of the way in which it is brought into operation, which may greatly vary. In the Waverley Model, diagnosis (phase two) proceeds towards and is the basis for resolution (phase three). The way in which phase three is defined adds gravitas to the Waverley Model’s ‘diagnosis’ as implying an educational process directed by an expert – the counsellor. Within the overview of the three-phase counselling process, phase three is articulated as follows: ‘This is the stage where the counselee is presented with the biblical solutions to his/her problem.’173 This description regarding the objective of phase three might be construed firstly on theological grounds, as evidenced by Hughes’ evangelical commitment stated in the CWR mission statement: ‘Applying God’s Word to everyday life and relationships.’ Secondly, the objective of phase three may be understood on personal grounds, given Hughes’ journey from evangelist to counsellor – Christian counselling as ‘problem-based evangelism’. Additionally, the language of ‘presentation’ to describe the method of applying the diagnosis and ‘interview’ as a synonym for a counselling session fits well with modernity – the philosophical backdrop of Hughes’ formative years. Having said this, Hughes himself referred to his model as ‘a framework not a straightjacket’. This sentiment and the adjustment of language within the Waverley literature allows students space to integrate the basic principles of