A new conception and subsequent taxonomy of clinical psychological problems

Abstract

Background A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline – psychiatry’s Diagnostic and statistical manual of mental disorders (DSM). Many have called for a ‘paradigm shift’ away from a medical nosology of diseases toward clinical psychology’s own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified. Main text An examination of DSM’s problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of ‘problem-maintaining circles’ (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to ‘counseling’, clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be ‘cured’ by PMC-breaking alone. Conclusion A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.

Atypical interoception as a common risk factor for psychopathology: A review

“… Schwartz et al, 2019 ), and there is an emphasis on the importance of individual case formulation, rather than relying on diagnostic categories, in clinical psychology (e.g. Bakker, 2019 ; Persons, 2008 ). This section is therefore focused on understanding the differences between individuals, and groups of individuals with similar manifestations of psychopathology, regardless of formal diagnosis.…”

Identifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study

“…Many psychosocial interventions are designed for targeting symptoms, which necessarily involves more remedial intervention strategies rather than preventive strategies that reduce risks and promote strengths (American Psychological Association, 2014). Moreover, many clinical psychologists engage in intervention decision making in a symptom-driven way (Bakker, 2019) – part of the motivation for developing the APA prevention guidelines was that, despite the increased focus on prevention within clinical psychology, there is little understanding of the best preventive practices (American Psychological Association, 2014). Considering how little guidance and experience clinical psychologists have regarding prevention strategies, it was notable that we achieved 100% or 50/50 consensus for skill recommendations for three of our four developmental mechanisms (i.e., heightened emotional reactivity, social information processing biases, and blunted reward processing).…”

Retiring Categorical Systems and the Biomedical Model of Mental Illness: The Why and the How—A Clinician’s Perspective

“…As a result, the DSM system poses widely acknowledged short-comings to understanding the true nature and sources of psychopathology, including low symptom specificity, prevalent comorbidity, pronounced diagnostic heterogeneity, and poor reliability (Clark et al, 2017;Krueger et al, 2018;Regier et al, 2013). Not surprisingly, "the biomedical model era has been characterized by a broad lack of clinical innovation and poor mental health outcomes" (Deacon, 2013: p. 846), and lack of clinical utility (Bakker, 2019).…”

“…The call made by psychologists and scholars to abandon the "Disease Model" of Mental Health and move to a "Psychosocial Model" abundant in the extant literature (Allsopp et al, 2019;Awenat et al, 2013;Bakker, 2019;Bentall, 2014;Deacon, 2013;Goldacre, 2014;Guerin, 2017;Hengartner & Lehmann, 2017;Kinderman, 2017;Middleton, 2015;Pemberton & Wainwright, 2014;Timimi, 2014) can no longer be ignored. Current traditional biomedical models that use categorical diagnostic approaches to mental health, such as those codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-created by the American Psychiatric Association (APA), and the International Classification of Diseases (ICD)-developed by the World Health Organization (WHO), have wielded a strong legacy in academic research, the mental health industry, and society at large (Dalgleish et al, 2020).…”