Questioning diagnoses in clinical practice: a thematic analysis of clinical psychologists’ accounts of working beyond diagnosis in the United Kingdom

Abstract

"Playing the diagnostic game" enables psychologists to manage an array of tensions and anxieties: conflicts between belief and practice, relationships with colleagues, and dilemmas of position and power. It also potentially limits a concerted questioning of diagnosis and consideration of alternatives. An alternative conceptual framework for non-diagnostic practice is needed to aid the collective efforts of clinical psychologists developing their practice beyond diagnosis, some of which have been highlighted in this study. Until then, ways of mitigating the perceived threats to questioning diagnosis need further exploration, theorising and backing.

Do clinical psychologists have a role in clients’ use of psychotropic medication? A mixed methods investigation exploring current forms of involvement

“…This is similar to the present finding that clinical psychologists factored in team context when weighing up decisions to be involved. However, Randall‐James and Coles (2018) found that making a stand and voicing difference was found to be courageous or troublesome by clinical psychologists, a concept not reflected in the current study. Within the context of emerging critical theoretical literature and empirical evidence towards the medical model (Johnstone et al , 2018), it was anticipated that findings might represent a largely critical stance erring away from supporting medication use.…”

“…Comparisons can be drawn with a study (Randall‐James & Coles, 2018) that many psychologists ‘played the diagnosis game’ to pursue change and balanced the need to get along with others whilst negotiating differences to make small changes. This is similar to the present finding that clinical psychologists factored in team context when weighing up decisions to be involved.…”

“…Coles, 2018).However, this practice was reportedly met with difficulty, as participants suggested a need to work with diagnosis due to the utility it can hold for the client, or to maintain working relationships. The authors concluded that an alternative conceptual framework for non-diagnostic practice was needed to support psychologists in working beyond diagnosis.…”

Pebbles in palms: Counter-practices against despair

“…At the same time, these small acts of resistance are said to promote broader and more substantial acts towards change in the longer term (Wade, ); to act in whatever small way now, means that we are more likely to act in such a way in the future, and perhaps to a more significant extent. An example of this is the small ways in which practitioners question and challenge what they deem to be unhelpful and/or unethical diagnostic practices making more sustained and collective action more likely over time—such as a shift from a focus on language usage within reports, to wider‐scale activism and protest (Randall‐James & Coles, ). As in our model above (Figure ) these small acts, or “pebbles” as we came to refer to them, also had the potential to ripple out and have an impact on a much grander scale.…”