How Does Psychiatric Diagnosis and the Language of ‘Disorder’ Shape Humanistic Counselling Practice? A Qualitative Reflexive Thematic Analysis

Abstract

Background

Humanistic approaches to counselling traditionally adopt a nonpathologising stance whereby distress is understood in the context of client subjectivity, rather than standardised diagnostic criteria; yet medicalised language and labels increasingly accompany clients into the counselling room and frame how many people understand their experience. Existing research exploring the influence of psychiatric discourse upon attitudes and approaches of mental health professionals does not include humanistic counselling professionals, despite clear tensions between humanistic and psychiatric paradigms. This study sought to address this gap by exploring the interplay between humanistic counselling practice and psychiatric discourse through the lived experiences of humanistic counselling professionals in Ireland.

Method

Using reflective thematic analysis, this qualitative study conducted semi-structured interviews to explore the attitudes and approaches of (N = 7) humanistic counselling professionals in Ireland towards psychiatric discourse and working with clients given a psychiatric diagnosis. This research was explored through the lens of critical realism.

Findings

Four themes are reported in this paper: (i) therapist attitudes, (ii) therapeutic approach, (iii) training, knowledge and understanding, and (iv) therapist resistance to psychiatric discourse. Evidence of incongruent, suspicious and pessimistic attitudes among participants towards clients presenting with a psychiatric diagnosis was identified within the data. These attitudes may be shaped by stigma and stereotypes associated with a client's diagnosis. Participants described directive and cautious approaches to working with clients diagnosed with a ‘disorder’, and at times appeared to prioritise management over the meaning of ‘symptoms’. Counselling education may play a role in counsellors' attitudes and approaches to psychiatric discourse. Attempts to resist the dominance of psychiatric discourse in practice were evident throughout the data.

Conclusion

Findings of this study suggest that psychiatric language may threaten the integrity of humanistic counselling practice through incongruent attitudes, focus on ‘fixing’ and pessimism among therapists when clients are viewed in terms of psychiatric ‘disorder’. The results of this paper invite therapists to reflect critically upon their relationship with psychiatric discourse. This includes consideration of the influence of any taken-for-granted knowledge of psychiatric ‘disorder’ and how this may shape their attitudes and approach to counselling practice. Further research might examine the hidden assumptions that therapists hold with regard to psychiatric discourse.