Tools for Strengths-Based Assessment and Evaluation - Springer ...

1 Strengths and Psychotherapy 7
of Diseases (ICD). In this case, they represent the “heuristic social artifacts” (Maddux, 2008,
p. 63) serving the social order and echoing the social value judgments of our culture.
McLaren (2010b) furthers these views with the argument that psychiatry has never been
able to articulate “a model of mental disorder that, ab initio [from the beginning], dictated
the borders and contents of mental disorder” (p. 193). Instead, psychiatry has relied on a
reductionist stance that views disorders as a disease of the brain (e.g., Bennett & Hacker,
2003; Guze, 1989; McLaren, 2010a,b), emphasizing poor adjustment over healthy adjustment,
abnormality over normality, and sickness over health (e.g., Maddux, 2008; McLaren,
2010b). These views are seen in the ominous writings of many who agree that the current
process is unlikely to change with the advent of the fifth edition of the DSM in 2013 and
the 11th edition of the WHO’s ICD in 2014 (e.g., First & Wakefield, 2010; Frances,
2009a, 2009b; McLaren, 2010a,b; Wakefield, 2010). As McLaren (2010b) notes “trying
to derive a classification of mental disorder when we do not even have a model of how it
arises is totally back to front” (p. 193). From an illness ideology, mental disorder must be
categorically distributed. However, most in the field recognize both mental disorder and
mental health as multidimensional, existing on a continuum, and dependant on individual,
culture, and context.
Times They Are a Changing
Let’s return to the question, what is the current state of psychotherapy? In the simplest terms,
Hubble, Duncan, Miller, and Wampold (2010) report that “the field is maturing” (p. 24).
Throughout the helping professions “the times, they are a changing” (Strümpfer, 2005,
p. 22). The field has begun to reinvent itself against the past 50 years of illness ideology, allegiance
with managed care, and medicalization of mental health (Becker & Marecek, 2008).
This reinvention seems to be away from a deficits paradigm of client dysfunction/frailty to
one where client strengths, resources, and competencies are part of the focus for change.
Indeed, exploring the strengths of individuals is hardly new and we believe the field is headed
over and beyond the popular cultural zeitgeist as it has been characterized (e.g., Held, 2002;
Strümpfer, 2005). To paraphrase Maddux (2008) once again, an important strengths ideology
has emerged, which is not focused on a categorical framework (you either have strengths or
you do not), but instead takes a multidimensional view of mental health (i.e., there are all
shapes and sizes of one’s strengths, some big, some small, all worthwhile).
A MULTIDIMENSIONAL VIEW OF WELLNESS
Following the definition and history of strengths, we next move toward an expansive view
of mental health that can be translated into clinical practice. Of importance is the need to
move away from an illness and deficit point of view with which much of the helping professions
have traditionally been conceived. As stated previously, the history of debate about the
categorical distribution of mental health is long and not likely to be resolved with the forthcoming
application of the DSM-5 (e.g., First & Wakefield, 2010; Frances, 2009a, 2009b;
McLaren, 2010b; Wakefield, 2010). However, as Mechanic (1999) aptly stated, “although
the concept of positive mental health is one worth keeping in mind, it is not very helpful in
classifying different persons, groups, or populations” (p. 2). Within this context, a number
of authors have put forth ideas that an inclusive, multidimensional view seems warranted;
one that is inclusive of both strengths and illnesses (e.g., Antonovsky, 1979, 1987; Keyes,
2007, 2009b; Keyes & Magyar-Moe, 2003; Ryff, 1989; Ryff & Keyes, 1995).
More Than the Absence of Illness
Conceptualizing mental health has generally focused on the pathogenic model that views
health (or complete health) as the absence of disease, a term that is consistent with the