On a daily basis I struggle in my work as therapist how I can understand the problems my clients present with. My employer and colleagues use the term ‘disorder‘ and view my work as ‘treatment‘. The central idea is that when symptoms subside, quality of life will improve. And even though quality of life gets more and more focus, the way to achieve it is by symptom reduction. But I don’t treat symptoms or disorders and quality of life is not being symptom free in my book.

Should we think in terms of disorders as categorizes in DSM or ICD? There is a lot of criticism on this view. Categorizing disorders was meant to find underlying causes, that could be taken away. Like bacteria that make us sick can be cured by penicillin. But decades of research into causes: (neuro) biological, genetic, brain functioning etc has not delivered.

Rising are network models, that try to cluster symptoms in new ways, building on the idea that symptoms influence each other and form networks[1]. Departing from this model it seems logical to concentrate on alleviating symptoms. When certain central symptoms decline, this will influence other symptoms favorable. For example when someone sleeps better, his concentration will improve.

Others prefer to research the influence of trans diagnostic factors. Examples of these are perfectionism, (negative) self image, emotion regulation or well being. These factors are supposedly affecting several disorders at the same time. Targeting those factors could positively influence a disorder and co-morbid problems at the same time.

We can also see getting stuck in life as an adaptation to a changing context falling short. Symptoms are the result of the tension between stress and coping. Symptoms are part of life. Or, like Strosahl, Robinson and Gustavsson say: “Life is one big symptom generator”[2] (Page 51). Thus: people do not have to be cured of symptoms or disorder.

Form this point of view we can help people relate differently to sources of stress. For some people this may mean to learn specific skills, like assertiveness, planning, communicating. For others it may mean finding creative solutions for permanent disabilities like blindness or a chronic disease. And sometimes we don’t know (yet) whether someone lacks skills or has to deal with permanent disability. When people struggle with perspective taking[3], of their own or the perspective of someone else, for instance with autism, psychosis or personality disorders, can we find ways to teach them? Or do we lack the tools (for now)?

And then it could be that we need meta-skills to be able to learn better. Skills that help us improve the process of learning.  The ACT model is about meta-skills. When we are able to accept, defuse and take perspective, when we are in the now, know our values and can life accordingly, we will be able to adjust ourselves time and time again to changing circumstances, we will find new ways to cope with the stress of living.

© J. A-Tjak.

[1] Cramer, A. O. J., Waldorp, L. J., Van der Maas, H. en Borsboom, D. Comorbidity: A network perspective. Behavioral and Brain Sciences 33, 137-193.

[2] Strosahl, K., Robinson, P. & Gustavsson, T. (2012). Brief interventions for Radical Change. Oakland: New Harbinger Publications.

[3] McHugh, L., Stewart, I., en Williams, M. (2012). The Self and Perspective taking. Oakland: Context Press