Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Arts

Program

Education

Supervisor

Brown, Jason

Abstract

Counselling is becoming more standardized under a medicalized discourse of diagnosis and manualized treatment partly due to changing standards and administrative needs (Strong, 2017). Through semi-structured interviews and thematic analysis, this study explored how social justice-oriented counsellors are impacted by the medicalization of counselling. Counsellors stated medicalization was pathologizing individuals, marginalizing groups, and homogenizing therapeutic work. Driven by systems and industries gatekeeping resources, maintaining the social status quo, and the profession’s pursuit of prestige and profit through the medical model, the medicalization of counselling has been steadily growing. Counsellors centered the profession’s emerging identity as primarily relational in the nature of the work, with client-centered and feminist approaches reducing the power differential between client and counsellor. Counsellors believed that decolonizing counselling and adopting a multicultural, trauma-informed, and de-pathologizing approach to assist clients through holistic and individualized treatments would be beneficial to clients and the counselling profession.

Summary for Lay Audience

The treatment of mental health problems through counselling is becoming more similar to the treatment of physical health problems through medicine. A focus on individual biology and characteristics, standardized therapeutic practises, and the expansion of which issues can be considered health issues or disorders (such as grief, trauma, and substance use) contribute to a medicalized approach to mental health and its treatment. A medicalized approach to counselling has a number of problems from a social justice perspective, including locating mental health problems within the individual, not accounting for social and environmental impacts on mental health, and diagnoses being used as a method of social control. To understand how the medicalization of counselling is impacting counsellors who use a social justice perspective, this study conducted semi-structured interviews and analyzed their statements to create five themes.

Counsellors stated medicalization was pathologizing people due to its perspective of issues emanating from within individuals, which particularly impacts marginalized peoples due to systemic discrimination and inequality, environmental impacts that are not accounted for in the individualized model. The medicalization of counselling is seen in the narrowing of therapeutic modalities supported by insurance, such as standardized treatments like cognitive behaviour therapy. Counsellors reflected these changes are driven by governments and companies’ desire for low-cost therapy, maintaining the social status quo, and counsellors pursuing prestige and profit through the medical model. Counsellors stated counselling should be relational, holistic, and focused on the client’s individual characteristics, treatment preferences, and power within therapy to reflect multicultural, trauma-informed, and decolonial practises.

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