The link between the Biomedical Paradigm and a range of Therapeutic Approaches

Nuria Outeiral
Written by Nuria Outeiral

To begin, it is essential to acknowledge the tensions that arise between the dominant biomedical model in contemporary medical practice and the psychological paradigm adopted by therapists who work with individuals experiencing emotional distress.

The increasing medicalisation of suffering reflects the widespread societal belief that mental conditions mirror physical illnesses, amenable to diagnosis and treatment similar to a common cold or infection. The notion that a significant portion of psychological distress can be seen as symptoms of an underlying pathological process or a chemical imbalance, and should be addressed with prescribed psychiatric medications, aligns with a disease-centered approach in line with the prevailing biomedical paradigm that shapes the science, policies, and practices in mental health services today.

However, it is important to note exceptions, as certain diagnostic categories such as “personality disorder” and “post-traumatic stress disorder” are approached as responses to trauma or developmental issues, rather than immediately presuming an underlying pathological mechanism.

Holistic approach to mental health services

Of course, the prevalence of the biomedical approach does not negate the existence of mental health services advocating for a more holistic approach. Yet, incorporating psychological therapies, particularly alongside psychiatric medications, can pose a challenge. Most psychological therapists hold an approach that clashes with the prevailing disease-based paradigm. These therapists, irrespective of their orientation, rely on models that emphasise the psychological and psychosocial aspects of experiences, considering them as the sources of mental suffering, rather than focusing on models centered around deficits, symptoms, and medicalisation.

Nevertheless, the deep-seated cultural influence of the biomedical model continues to shape attitudes, beliefs, and values of therapists of various orientations. The professional backgrounds of each therapist, as well as their education and work context, along with their personal preferences, play a crucial role in shaping their therapeutic approach. For example, therapists working in environments that prioritise a biomedical approach may use psychiatric classification terminology, standardised assessments, and clinical interventions. On the other hand, therapists who lean towards humanistic perspectives or adopt an “expert” stance opt to highlight emotional connection, collaborative teamwork, personal responsibility, and granting clients the autonomy to guide themselves. The core principle for humanistic therapists revolves around accompanying instead of directing the client, indicating that their focus is not on compelling or pushing clients to make alterations in their lives. Instead, they lean towards aiding clients in assuming self-responsibility through an attitude of curiosity, exploration, and a joint and compassionate acceptance.

Array of therapeutic approaches

Within the realm of training and therapeutic practice, a diverse array of therapeutic approaches spans a broad spectrum. This spectrum encompasses traditions rooted in psychoanalytic paradigms, such as the psychodynamic models and notable therapies like Beck’s Cognitive Therapy (CBT), Dialectical Behavior Therapy (DBT), and Rational Emotive Therapy (RET). Additionally, there are those that fall under the category of “third-generation” methodologies, exemplified by Mindfulness-Based Cognitive Therapy (MBCT), Compassion-Focused Therapy (CFT), and Acceptance and Commitment Therapy (ACT).

Central to these paradigms is the concept of transference and countertransference content. Here, the client is conceptualised as having internal divisions, and the therapeutic endeavor strives to bring latent unconscious content to the forefront, making it accessible for collaborative exploration alongside the therapist. In the case of CBT practitioners, a collaborative approach prevails, emphasising a therapeutic alliance and shared goals rather than adhering to the “expert” role typically associated with the biomedical model. The utilisation of psychoeducation and self-regulation strategies aids clients in recognising and addressing ineffective patterns of thought, behavior, and conduct that contribute to psychological challenges.

Regarding the previously mentioned perspectives, it’s evident that each entails significantly different assumptions regarding the nature of emotional suffering. From the biomedical paradigm, the majority of mental suffering is considered a “disorder” or “symptom” to be eliminated through the administration of psychiatric medication. On the other hand, in humanistic and psychodynamic traditions, suffering is conceived as something with a purpose and potential value rather than being merely “pathological” or futile. Therapists adhering to these traditions tend to perceive emotional suffering as a signal that something is not functioning correctly in the person’s life.

Awareness is growing

Healthcare professionals and patients alike are growing more cognisant of the choices presented by alternative medicine or non-traditional therapies. In the recent surge of alternative remedies infiltrating the realm of mainstream medicine, the dichotomy of conventional versus alternative medicine dissolves. Instead, a singular distinction emerges: medicine validated by rigorous testing versus medicine awaiting such scrutiny—medicinal effectiveness contrasted with potential ambiguity. Once subjected to thorough examination, the initial classification of a treatment as alternative becomes immaterial, as long as it demonstrates safety and efficacy. This perspective contends that the division between Eastern and Western practices or the division between unconventional and mainstream methods holds minimal relevance. In aligning with a scientific and evidence-based ethos, the core focal points must revolve around the patient, the targeted ailment, the proposed therapy, and the essentiality of substantiated evidence concerning safety and therapeutic progress. All treatments, whether conventionally accepted or alternative, ought to adhere to the rigorous standards of the scientific method. The demarcation between alternative and conventional medicine becomes discernible when the efficacy of diverse alternative treatments lacks validation through double-blind randomised controlled trials. In stark contrast, conventional pharmaceuticals gain market approval solely following the establishment of their efficacy through such trials. Instances arise where symptomatic alleviation could be erroneously attributed to an ineffective therapy due to the placebo effect, the natural course of recovery or the cyclic nature of an ailment (termed the regression fallacy), or the potential absence of a genuine malady from the outset. Proponents of Complementary and Alternative Medicine (CAM) note that these factors could also be applicable to conventional treatments. Conversely, skeptics of CAM underscore that this argument does not account for the success of conventional medicine as proven through rigorous clinical trials.

Autonomy in healthcare selection

Individual autonomy in healthcare selection is paramount, yet with a caveat demanding informed comprehension of the safety and efficacy of the chosen approach. Advocates of alternative medicine may assume they are embracing a dependable, potent remedy, yet unwittingly partake in unsubstantiated treatments. Notable instances emerge where an individual’s favorable experience with one alternative remedy for a minor affliction incites a conviction in its efficacy, subsequently encouraging an extrapolation of success to a more severe, potentially life-threatening ailment. Detractors assert that therapies relying on the placebo effect as a gauge of triumph hold inherent peril. Unsubstantiated health practices can drive individuals to disregard proven treatments. Substantial investments of time and resources into ineffective therapies may leave individuals bereft of both, sacrificing the prospect of accessing genuinely beneficial treatments. A compelling call resonates for expanded research to validate the effectiveness of complementary therapies before they gain foothold within formal medical practice. The onus lies upon amassing sufficient evidence, either biologically or clinically plausible, to warrant the expenditure of efforts in exploring the merits of alternative medicine. In the end, the sanctity of human life mandates the safeguarding of health without the gamble of compromise.

Maybe it is time for Health professionals to assume a more proactive stance, equipping themselves with knowledge about these healthcare treatment alternatives, to assist patients in making well-informed choices that conform to the rigorous standards of the scientific approach. Furthermore, this may also serve as a way to enhance the patient’s comprehension regarding the field of mental health and the application of psychology.  As an example, contrary to common belief, mental health professionals who prioritise evidence-based approaches, frequently propose incorporating lifestyle adjustments alongside developing a range of therapeutic skills aimed at mitigating symptoms acquired during psychotherapy.

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