If we look at the range of therapies on offer in the marketplace, ambivalence of non-medical therapists towards diagnosis remains. Pentony (1981) notes that broad affiliations exist within three separate rationales for personal change:
This long but still partial list of forms of therapy reminds us that the therapeutic understanding of mental health problems is not a monolith. Each therapy brings with it separate and sometimes quite discrepant versions of formulation. These subsume different assertions about relevant antecedents of problems (which may or may not retain the notion of ‘aetiology’) and different explanations. Given this picture, what potentially opposes psychiatric diagnosis is not formulation but formulations. Vigilance is required by advocates of each therapeutic approach to construct and reproduce a particular and distinctive rationale because tribal membership, hierarchical status and salaries rely upon it.
Thus, a formulation is both a rationale for counsellors and psychotherapists within a school (about antecedent and maintaining factors relevant to particular problems and their resolution) and a rhetorical device to claim particular expertise about mental abnormality. Therefore, the ideological battle that ensues within the mental health professions is not merely between those who are biologically minded with their diagnoses and those who are psychotherapeutically minded with their formulations.
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