Beyond the DSM/ICD framework: On what basis do psychotherapists understand clients’ psychological impasse?
Beyond the DSM/ICD framework: On what basis do psychotherapists understand clients’ psychological impasse?
DOI:
https://doi.org/10.1243/t0rhjt94Keywords:
DSM/ICD, HiTOP, Process-Based Therapy, Transdiagnostic approachAbstract
In contemporary clinical psychology training and practice, heavy reliance on diagnostic classification systems such as DSM-5 and ICD-11 may constrain clinicians’ ability to understand complex psychological difficulties, particularly among subthreshold and comorbid presentations. This article proposes a complementary perspective grounded in transdiagnostic models, including the Hierarchical Taxonomy of Psychopathology (HiTOP) and Process-Based Therapy (PBT), emphasizing a shift from “syndrome-based diagnosis” to “process-based analysis”. Through a case analysis combined with a review of recent literature, the paper illustrates how interventions targeting core psychological processes—such as psychological flexibility, self-compassion, and emotion regulation—may produce broader and more sustainable outcomes than symptom-focused approaches alone. This framework enables personalized intervention planning and applies to clients who do not meet full diagnostic criteria. The paper argues that understanding the underlying processes of mental functioning represents a significant direction for the future of psychotherapy.
References
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., & Allen, L. B. (2017). The unified protocol for transdiagnostic treatment of emotional disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875-884. https://doi.org/10.1001/jamapsychiatry.2017.2164.
Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., & Moffitt, T. E. (2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders?. Clinical Psychological Science, 2(2), 119-137.
Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford University Press.
Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger.
Hayes, S. C., Hofmann, S. G., & Ciarrochi, J. (2019). A process-based approach to psychological diagnosis and treatment. Current Opinion in Psychology, 30, 5-10.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
Hyman, S. E. (2010). The diagnosis of mental disorders: The problem of reification. Annual Review of Clinical Psychology, 6, 155-179.
Johnson, J. C. S., Byrne, G. J., & Pelecanos, A. M. (2022). The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: From a nationally representative survey of 36,309 adults. BMC psychiatry, 22(1), 270.
Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. American Journal of Psychiatry, 160(1), 4-12.
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders. Archives of General Psychiatry, 62(6), 617-627.
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., ... & Zimmerman, M. (2017). The hierarchical taxonomy of psychopathology (HiTOP). Journal of Abnormal Psychology, 126(4), 454-477.
Kupfer, D. J., Regier, D. A., & Kuhl, E. A. (2008). On the road to DSM-V and ICD-11. American Journal of Psychiatry, 165(6), 645-648.
Miller N. S. (1994). Psychiatric Comorbidity: Occurrence and Treatment. Alcohol Health and Research World, 18(4), 261-264.
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge.
Zhang, R., Peng, X., Song, X., Long, J., Wang, C., Zhang, C., … Lee, T. M. C. (2023). The prevalence and risk of developing major depression among individuals with subthreshold depression in the general population. Psychological Medicine, 53(8), 3611-3620.
