The Diamond Model of Modalities – The force field between medical model, working alliance, enactment (2004)

The Diamond Model of Modalities – The force field between medical model, working alliance, enactment (2004) 2017-04-07T03:00:46+00:00

Project Description

This handout presents the underlying force field and fundamental tension which the therapeutic endeavour operates within. Historically, and in the public (mis-)perception, therapy is seen as equivalent with 'medical model' treatment, i.e. symptom reduction through the therapist operating as a 'doctor for the feelings' (or the mind/mental states, in some people's perception). Whether amongst ourselves we agree with this construction or not (and amongst a significant fraction of the therapeutic field there is vehement disagreement and opposition to the 'medical model'), we need to make some kind of alliance with the client who is bound to labour under that misperception. For the opposite faction (i.e. those who subscribe to the 'medical model' without hesitation or misgivings), there is no issue, because they assume the working alliance by virtue of the patient walking through the door and wanting help. For those of us who hold a paradoxical third position between these ideological extremes, we can see the fallacies of each of these positions: as long as the client is paying us, they are entitled to certain expectations, whether these are valid in our opinion or not (we get paid to make some 'better', and we do take responsibility for that fact); on the other hand, to assume cooperation and working alliance just because the patient turns up, is profoundly naive, as we see a whole host of rational and irrational, good and bad reasons why the client is coming to us, and under which preconceptions. So, for those of us who hold that paradoxical third position, the situation is complex, ambiguous and complicated. We operate within the ongoing tension between these positions and we see the inherent conflictedness and 'artificiality' of the therapeutic space somewhat like a magnetic field in which the client's own conflicted experience becomes visible like iron filings. On the basis of that crucial recognition, we do not see the force field as static, but as profoundly dynamic, with the working alliance going through cycles of rupture and repair in a way that can become profoundly transformative. But this potential of the field only becomes activated once we can inhabit and surrender to its paradoxical and non-linear nature.

 

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