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Let us consider how we determine goals for our al., 2010) are forsaking a diagnostic approach to
counselees and whether there may be room for counseling and advocating for transdiagnostic
improving how we do so. This may ensure we treatments.
are not working at cross-purposes with God. The Christian counselor or therapist will see a
We will reflect on this by considering a series of spiritual and/or moral element in play in many
four questions. presenting problems, and a diagnosis from a
secular manual built on a disease model leaves
Do We Treat Diagnoses or Problems? no room for this. The disease model leads to an
interpretation of problems as symptoms of me-
Christian counsel was historically done from dical illness. Sometimes they are (even biblical
within the church and by spiritual leaders, see- counselors acknowledge that brain damage can
ing the issues people came with as problems and impact psychological functioning [e.g., Scott,
sometimes even as sin. The advent of the sci- 2012]), but is a disease model the way to start
entific method led to efforts to see problems as determining where counseling is to go? It mini-
less spiritual and as more physical. Largely due mally imposes an interpretive framework over
to the influence of Freud who “medicalized” the the description a counselee might present, and
notion of counseling into psychotherapy, the once bought into, starts one down an interpre-
current model of the mental health professions tive road that may not be ideal.
is that one diagnoses a mental illness and that
will lead to the notion of how to treat it. Trai- How Do We Formulate the Problem?
ning for counselors generally includes a course
in the ICD or DSM, with the assumption that a Since the disease model really does not work,
good diagnosis tells what the goals of treatment psychology and counseling have struggled to
should be. come up with the “disease” process leading to
Even research shows this medical model does symptoms. Take something as basic as depres-
not work so well (Wampold & Imel, 2015). sion. This is already an interpretation of a set
Compare this approach to dealing with strep of symptoms that might include loss of sleep
throat. A swab test will determine the presence (or excessive sleep), low mood, and negative
of streptococci in the person, and these bacteria thoughts. Must these reflect a disease, or a state?
are identified as the culprits responsible for the They might even be what St. John of the Cross
illness. Research has made clear that antibio- called a dark night of the soul, not a mere im-
tics will kill the streptococci, and thus the pati- balance of brain chemicals as some would have
ent will get well. So, the goal is to kill the strep us believe.
germs and antibiotics do the trick. A good dia-
gnosis makes the approach to treatment clear. But let us assume the medical model for a mo-
ment and agree with a diagnosis of depression.
In counseling, however, this does not obtain. Even with this point of departure, a counselor
No psychiatric diagnosis has a simple, clear, un- now must choose among a bounty of models of
disputed etiology like the one we see in strep. counseling to find the “cause” to “fix” the pro-
Therefore, we only have symptom clusters and blem. Each will offer its own formulation of the
no firm idea of the etiology of those symptoms depression leading to the goal of therapy.
and what holds them together. This leads to Of course, Freud would have the depressed in-
considerable comorbidity as the diagnostic dividual talk about his or her early childhood
categories are not discrete, and to conflicting and look for signs of fixations or defenses that
theories of the processes that lead to the dia- may explain the problem and thus the goal of
gnosis. In short, psychiatric diagnosis is not therapy is to get “unfixated” or see behind de-
helpful in determining treatment. Even medica- fenses.
tions are now seen as treating symptoms more
than mental disorders. Renowned psychothera- A cognitive behavioral therapist is more likely
py researchers such as David Barlow (Barlow et to tout the science behind this approach and

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