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Diagnosis |
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George Kelly (1955, p. 775) viewed
psychiatric diagnosis as ‘all too frequently an attempt to cram a
whole live struggling client into a nosological category’. His
alternative approach, which he termed ‘transitive diagnosis’, was to
use diagnostic dimensions focusing upon the avenues of movement open to
the individual rather than a classification system based upon disease
entities (Johnson et al., 2000). These diagnostic dimensions include constriction - dilation;
and tight - loose
construing. Other diagnostic constructs used by Kelly, and described in
other sections of the encyclopaedia, are preverbal
constructs; submergence; suspension; level of cognitive
awareness; comprehensive constructs; incidental constructs; superordinate constructs; subordinate
constructs; regnant constructs; core constructs; peripheral
constructs; and
various constructs relating to transitions in construing (e.g. threat; fear; anxiety; guilt; aggressiveness; hostility; the circumspection-preemption-control
cycle).
Kelly (1955, p. 831) defined as a disorder ‘any personal
construction which is used repeatedly in spite of consistent
invalidation’. Disorders involve a failure to complete the process
of experimentation outlined in the experience
cycle. They may
be regarded, just like the constructions of non-disordered people, as
the individual’s attempt to make the best sense of his or her world and
to cope with or avoid invalidation. To this end,
all of us use the strategies described in Kelly’s diagnostic
constructs,
but while in the optimally functioning person there is a cyclical and
balanced interplay of contrasting strategies, in disorders there tends
to be the
almost exclusive use of a particular strategy. Disorders may therefore
be
classified in terms of the strategies which most characterise them
(Winter,
1992, 2003). Similarly, they may be viewed in terms of the
"nonvalidation
strategies" which the individual uses in order to avoid making
sense of
some
aspect of his or her world (Walker et al., 2000).
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References
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- Johnson,
T.J., Pfenninger, D.T., and Klion, R.E. (2000). Constructing and
deconstructing transitive diagnosis. In R.A. Neimeyer and J.D. Raskin
(eds.), Constructions of Disorder: Meaning-Making Frameworks for
Psychotherapy. Washington, DC: American Psychological Association.
- Kelly,
G.A. (1955). The Psychology of Personal Constructs. New
York: Norton (republished by Routledge, 1991).
- Walker,
B.M., Oades, L.G., Caputi, P., Stevens, C.D., and Crittenden,
N. (2000). Going beyond the scientist metaphor: from validation to
experience cycles. In J.W. Scheer (ed.), The Person in Society:
Challenges to a Constructivist Theory. Giessen: Psychosozial-Verlag.
- Winter,
D.A. (1992), Personal Construct Psychology in Clinical
Practice: Theory, Research and Applications. London: Routledge.
- Winter,
D.A. (2003). Psychological disorder as imbalance. In F.
Fransella (ed.), Personal Construct Psychology Handbook.
Chichester: Wiley.
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David A. Winter
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