Diagnosis as an Attempted Solution: A Framework Model for Indication and Process in Systemic Therapy

This paper proposes that diagnoses in outpatient psychotherapy be understood as attempted solutions of the therapeutic system. A diagnosis is a pattern description by which an observing system establishes its capacity to act; a symptom is a pattern description by which the client system does the same. Whether a diagnosis is given is therefore a framing decision, not a finding about the person, and the place of this decision is the psychotherapeutic consultation hour. A model with four dimensions is developed: frame (diagnosis or none), perspective (client system or therapeutic system), viability and congruence of a pattern. The model yields four process fields, describes change as a trajectory through a liminal phase, and names two directions of error, over-pathologization and under-treatment. The scope is outpatient psychotherapeutic indication; psychiatric illnesses with a substantially medical or neurobiological basis are excluded. Theoretical paper; no empirical data. English translation and German original.