Selasa, 17 September 2013
Perhaps no topic in the counseling literature has generated as much controversy as the question of when, how, or if psychological tests and interventions should be used. Like many emotionally charged issues, this one has generated more heat than light, along with more than its share of misunderstanding and confusion.
The use of tests in counseling must be considered part of the overall diagnostic process. That is, they are part of the counselor's total effort to understand clients, and, out of that understanding, to be helpful. Thus, we can examine the use of tests within this general framework: do tests help us to understand clients better and to be more helpful?
The process of diagnosis in counseling is most effective, however, when it is continuous, tentative, and testable. Because the process of diagnosis permeates and pervades the entire process of counseling, diagnosis is an ongoing process of continuous modification of our impressions and perceptions of clients.
We can conceptualize human effectiveness as the ability to obtain long term control over the significant features of an individual’s physical, social, and psychological environment. In this sense human effectiveness is not purely an intrapsychic trait; rather it is a measure of the quality of the person-environment interaction at particular times and in specific circumstances.
We can categorize person-environment transactions within a unitary model that specifies five levels of interaction that include the cognitive, affective, and behavioral components of that interaction.
The process by which counselor attempt to reach out and to understand has been the subject of great controversy and not a little confusion and misunderstanding over the years. The earliest attempt to describe the process was termed, perhaps unfortunately, “diagnosis” (Williamson, 1939).
The term was borrowed largely from medicine and came to process connotations and meanings that were quite foreign, and in some instances, repugnant to counselor. In any event, the process of diagnosis and its role within the total intervention process is quite different in counseling from what it is in medicine.
Traditionally, the process of diagnosis in medicine has been concerned primarily with the presence of disease entity within the patient. Measles, mumps, chicken pox, polio, pneumonia, and influenza are disease entities. They present distinct symptoms, are caused by specific infectious agents, and have known differential treatments associated with them. Much of the progress of medical science has involved the identification of disease entities, the discovery of their causes, and the formulation of specific remedies. In this sense, diagnosis typically involves the study of symptoms, the use of laboratory tests, and finally a prescribed course of specific treatment. Within this model diagnosis necessarily precedes treatment and represents a distinct stage in the total process of treatment.
However, even in medical settings attempts to apply this type of process to so-called “mental illnesses” have not been notably successful. The nature of presumed disease entities in the “functional mental illnesses” has proved to be different from those types of pathology for which specific organic causes can be established (Eysenck, 1961).
Evidence about the relatively low reliability and limited utility of traditional psychiatric diagnoses led Eysenck to suggest that the whole notion of disease entities should be banished from modern psychology. Nonetheless, despite this controversy, work on the medical model of diagnosis in psychopathology has proceeded.
The American Psychiatric Association has published three editions of its Diagnostic and Statistical Manual of Mental Disorders. The Third Diagnostic Manual (DSM III) designed to be a more reliable system for diagnosing mental disorders within a medical, disease entity model (American Psychiatric Association, 1980), includes somewhat more specific and operationally defined criteria than were found in the first two manuals. However, it should be understood that for most of the categories the criteria are still based upon clinical judgment and have not been fully validated.
The DSM III is considerably more comprehensive than earlier editions and marks a clear attempt to bring a wider range of human concerns, including developmental, educational and vocational, problems under the rubric of “mental disease.” In this sense, it is as much a political document, staking out the territory of organized psychiatry, as it is an attempt to provide a scientifically defensible system of classification (McReynolds, 1979).
In previous chapters we have discussed the philosophical and professional limitation of the intra psychic disease entity models. Many counselors have reacted negatively to the medical model of diagnosis and for very good reasons. The risk of stigmatizing clients with labels that are both vague and frightening, the possibilities of creating “person blame” approaches that solve social problems by scapegoating powerless people, and the erosion of personal responsibility by translating all sorts of human concerns into sicknesses have caused many counselors and counseling theories to shun traditional models of diagnosis and to regard the term itself as anathema.
We should note that not even all psychiatrics diagnosis support disease entity models. Benjamin (1981) reviewed the history of psychiatric diagnosis and deplored attempts at “remedicalizing” psychiatric diagnosis. Menninger (1963) proposed that unitary models of diagnosis be developed to enable clinicians to conceptualize levels of client functioning without involving notions of specific disease entities with all of the untested assumptions that these entail. He noted that disease entity models totally fail to describe upper levels of human functioning, or what he called being “weller than well.” Prugh (1973) has proposed a unitary model that develops a diagnostic system based on the departures from the optimal personal and family functioning of children at specific age levels.
Such unitary models seem useful in evaluating efforts both at preventing obstacles to optimal functioning and at enhaching personal growth. One advantage of unitary models is that they can consider both the assets and resources available to individuals as well as the obstacles. What follow is a unitary diagnostic model to describe levels of functioning in relation to human effectiveness.
One activity that is characteristic of all approaches to counseling and psychotherapy is the effort to understanding of client’s world. However, this quest for understanding and empathy is not an easy one. Human being are forever separated from each other by various physical and psychological barriers. Differences in age, sex, ethnic memberships, socio-economic background, religious beliefs, political persuasions, and personal history make each human life unique and, to some extent, an inevitable mystery to every other human being. Personal counselor face the formidable task of attempting to bridge these many barriers in order to understand, empathize, and intervene in another human life.
The Hare was boasting of his speed before the other animals. 'I have never yet been beaten,'he said, 'Ichallenge any one here to race with me.'The Tortoise said quietly, 'I accept your challenge.'
'That is a good joke,'said the Hare. 'I could dance round you all the way, it will be easy.'
The race was fixed and the Hare and Tortoise lined up. The Hare shot out ahead at the beginning of the race, leaving the Tortoise behind. But he couldn't resist playing to the crowd. To make a fool of the Tortoise he ran back and forth and around him. He even stopped and had a nap. 'Look I can beat him easily, I can even take a rest in the middle.'
The Tortoise simply ignored the Hare and concentrated on the race, plodding forward at his own pace, his eyes fixed on the finishing post. In taking his nap,
the Hare forgot the time, and awoke suddenly to see the Tortoise nearly at the finishing line. He charged forward to try and catch up, but it was too late and
the Tortoise won the race.
The Hare and the Tortoise, adapted from The Fables of Aesop
A Lion was awakened from sleep by a Mouse running over his face. Rising up angrily, he caught him with his paw and was about to kill him, when the Mouse cried
'Forgive me this time and I shall never forget it.'
The Lion took pity on the Mouse and let him go. As he was leaving the Mouse said
'Who knows but I may be able to do you a good turn one of these days?' The Lion laughed at this idea saying
'How could you a little Mouse help me the King of the jungle?' Some time later the Lion was caught in a trap by hunters who wanted to take him alive to a zoo. The Lion roared out in fear and he was heard by the little Mouse who came to his aid. The little Mouse quickly gnawed through the ropes that bound the King of the jungle and freed him.
The Lion and the Mouse, Aesop