Diagnostic assessment and therapy as a problem-solving process

Definition

The process of assessment in medicine should determine the appropriate course of therapy. Thus, for any particular complaint, the assessment process should result in awareness of which treatments are likely to either cure the disorder (curative treatment) or reduce symptoms to a more tolerable level (symptomatic treatment).

As part of this process, the therapeutic aims need to be defined. Whilst in other areas of medicine this is often relatively straightforward, in psychotherapeutic fields, this is not the case, because the same problem can be viewed from a number of different perspectives (Schulte, 1991a).

Similar problems arise with the concept of treatment planning (Lau, 1980). The term ‘planning’ implies the conscious and rational weighing up of all possible therapeutic techniques, such that, in any particular clinical situation, certain aims will be set and methods will be chosen according to their appropriateness. Applied to psychotherapy, this involves the inherent assumption that psychotherapy can be viewed as a conscious and rational problemsolving process (Bartling et al., 1980; Caspar, 1987, 1989; Schmidt, 1984; Jäger, 1988; Steller, 1994; Rudolf, 1993). In contrast to this assumption, many therapists emphasize the importance of unconscious and irrational processes and come to the conclusion that many important aspects of therapy cannot be planned. Thus the concept of therapy planning remains a controversial issue (Schulte, 1991b; Schiepek, 1991).

Problem-solving model

Fig. 2.1 shows diagnostic assessment and therapy as a problem-solving process. In this schema, the assessment process and the treatment plan (with its inter-related components: problems, aims and possible interventions) are central to the model.