Biopsychosocial Model (BPSM)
When I was in graduate school the entire focus of the curriculum was predicated on the BPSM. My first thought was that it is some form of psycho-babble which sounds good but I suspected that it was bereft of meaning. I could not have been more mistaken. Now it would be impossible for me to do therapy without using the BPSM. What changed? I did.
I have learned that the BPSM is a structured way of assessing a client as a "whole" person. Again, I initially thought that this is just more of the same-a nice sounding phrase with no substance. Wrong again. When applying the BPSM we start at the beginning of a person's life. We assess a person in his/her environment including family relationships, living conditions, ethnicity, race, religion, education, hobbies, occupation, etc. When a client comes to therapy, I see a person who may have a problem or problems, but I don't conceptualize the client in terms of deficits or problems facing them. For example, if a client sees me in therapy for depression, I don't see a depressed person as much as a person who is suffering from depression but is not defined by that mental state. My first comment in therapy, "Please tell me about yourself (name). Invariably, the response is, "what do you mean?" or "what do you want to know? My answer is "please start at the beginning, like where you went to school, where were you born, who is in your family, etc? I want to know the client's biographical history. In order to do therapy, context is critically important.
The psycho part involves delving into why the client is seeking therapy. If it is depression, I will do a clinical assessment and try to learn as much as I possibly can about the circumstances and causes for depression. I want to know when it began, how it began, why it began and all details about medications and prior attempts to deal with depression. There is a narrative to be told and I want to hear the whole story. Say for example I am seeing a 45 year old client. Obviously, this client is in midlife. I use the analogy of, in the book of life, it is likely that the person is in chapter 5 of what may turn out to be a10 chapter book. When I read a book, I don't start reading it in chapter 5. I start at chapter 1 and read every page. Yes, I want to know what is currently happening in a person's life which brings him/her to therapy, but I need context to understand. Whatever is happening in chapter 5 is based on chapters 1-4. Then chapter 5 makes a lot more sense and I can conceptualize the "whole" person.
The social part of BPSM is trying to understand how the client interacts with his/her environment and with other people. Is the person reclusive? Is he/she nervous to meet people? How does the client gain his/her energy? Is he/she introverted? Extroverted? Suspicious of others? Untrusting? etc. It is all relevant. The BPSM is entirely dedicated to making an assessment of the "whole" person. All to often, I have seen inexperienced therapists not taking the time and effort to do a thorough BPSM, eager to jump in and "solve" the presenting problem the client has. The problem or problems become apparent when considered through the lens of having knowledge of all the chapters of a person's life which led up to the current chapter being written.
As an inexperienced therapist, I often made the mistake of going to "problem solving" much too early in treatment. I learned that there is no substitute and no short-cut for providing high quality mental health treatment. Granted, BPSM requires several sessions, BPSM is, in my opinion, the most effective intervention for completing a thorough Diagnostic Assessment.
