Toward a Grand New Model for Diagnosis and Treatment

Counselors might come to use the growing link between biology and psychology.

Posted Dec 13, 2018

Wikimedia, Public Domain
Source: Wikimedia, Public Domain

If we’re being honest with ourselves, the counseling professions are less effective than we’d want them to be. It's hard to face that because it would cause too much dissonance: How can we continue to work so hard to address our clients’ pain if we faced the uncomfortable truth that our toolkit's effectiveness is too-often limited.

But if we care about being helpful, we must face that and that our methods have changed little in decades, some would say a century: We ask questions about a person’s past and present, we listen, we reflect, we ask more questions, ideally leading a client to come up with their own insights and solutions, and if those are inadequate, tactfully propose our own. We may value a theoretical model but what we do in practice is mainly the aforementioned.

So there's a need for a breakthrough approach, but what? Except for perhaps throwing often not-good-enough drugs such as SSRIs at the problem, counselors and psychotherapists largely act as though biological science doesn’t exist. But it does and it has progressed significantly. For example, it wasn’t so long ago when psychologists thought that mental illnesses such as autism, depression, and schizophrenia were caused by bad parenting and other childhood trauma. Now, scientists have provided strong evidence that much mental illness has at least partly biological roots.

As knowledge of the biology/psychology relationship grows, might the counseling intake model of the future include a genomic profile, brain scan, and blood test? Such a model might lead to, for example,

  • a person seeing a career counselor to help choose a career being encouraged to pursue a high-stress career, where s/he ’d have an advantage because s/he secretes a below-average amount of adrenaline. S/he might be encouraged to consider an abstract mathematical career because s/he has an unusually large and differentiated sub-area of the brain related to abstraction ability.
  • a depressed person being treated with a combination of somatic gene-editing, a drug or hormone based on the genome, blood test, and brain scan rather than trial and error, plus cognitive behavioral techniques.
  • a weight-loss counselor using the genome and blood test results to help an obese person select a biologically well-suited appetite suppressant atop behavioral techniques and group support.

The takeaway

Virtually all of my posts here on deal with practical advice for self-helpers and counselors. In contrast, this article may be of interest mainly to researchers. But because we tend to be tunnel-visioned by our day-to-day exigencies, and to give myself a little reward for today having passed the 7-million mark in reader views of my Psychology Today articles, I thought it’s worth blue-skying a bit. I hope you agree.

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