"The Medical Metaphor: A Better Model?"

Characteristics: What exactly constitutes the "medical model" is difficult to articulate. Certainly there are varying degrees of adherence in practice. However, some general characteristics may be identified. These characteristics in their extreme may include unequivocal subscription to the disease model of emotional disturbance, a paternalistic hierarchy of providers, narrowly defined treatment parameters, nosological obsessions and nomothetic paradigms.

Given the history of psychotherapy practice including it's long-standing association with the field of medicine, it is not difficult to understand the dominance of the medical model. It is difficult even to criticize the model (as in the present article) without indulging in it's jargon. However, many characteristics of the medical model are less than desirable in the treatment of emotional problems. Criticisms abound; but some of the most relevant include the dehumanizing effect of the medical model, it's inherent lack of flexibility, indulgence of an oversimplified mind/body dichotomy, and creation of a myth of scientific accuracy along with unrealistic expectations about the predictability of etiology and course of the "illness."

Psychotherapy and the Medical Model

While psychiatry may indeed be a specialization within medicine, psycho- therapy is a discipline which has developed from many fields, including (but certainly not limited to) the physical sciences, social sciences and the humanities. This multi-disciplinary heritage yields both productive and counter productive aspects of psychotherapy practice. However, the history, development, and practice of psychotherapy would seem to indicate that the limitations of the medical model per se make it a highly restrictive and ultimately inappropriate paradigm for the practice of psychotherapy. Nonetheless, good or bad, the medical model is here to stay. While the dangers of reification of any abstract concept are obvious, the medical model presents a compelling analogy for the process of psychotherapy. Many alternative "models" have been proposed. However, it is likely to be in the best interest of all psychologists, especially those working in settings to be able to productively accommodate the medical model, within their practices. For this reason a discrete differentiation is proposed: "medical model" vs. "medical metaphor." This distinction may be considered too subtle by some and quite possibly many psychologists already make this distinction intuitively. However, in a professional era in which blurred distinctions between disciplines may be detrimental to both the practice and identify of psychology, it may not be overly excessive.

Why Medical Metaphor?

Webster's Dictionary lists a relevant definition of "model" as: "an example for imitation or emulation." A metaphor, in contrast is defined as "a figure of speech in which a word or phrase literally denoting one kind of object or idea is used in place of another to suggest a likeness or analogy between them." Thus, the medical model presents psychotherapy as a discipline striving to be like medicine while the medical metaphor depicts psychotherapy as a discipline with it's own identity that employs a figure of speech to convey the meaning and benefit of difficult abstract concepts. In addition, the use of metaphor facilitates the integration of contributions from psychotherapy's multidisciplinary heritage (including medicine) rather than the exclusion and devaluation of the humanities, social sciences, etc. that enrich our practice of psychotherapy and secure our identity as psychologists.

McCready, Kevin (1986), The Professional Psychologist, 8.
Introduction: Kevin McCready, Ph.D. is a staff psychologist and Director of Research at Kingsview Hospital in Reedley, CA. He also maintains a private practice in Fresno, CA and is a member of the Central Neuropsychiatric Hospital Association's Research Collaborative Group. He received his doctorate in Clinical Psychology from the California School of Professional Psychology in Fresno in 1983 and his Masters in Physiological Psychology from the State University of New York at Brockport in 1980. He is currently serving a 3 year term as chair of the Continuing Education Committee for the San Joaquin Psychological Association and is a member of CSPA and Division I..