Counselling psychologists’ experiences of working with clients with a psychiatric diagnosis: A grounded theory analysis

Many people who experience mental distress will receive a psychiatric diagnosis following assessment. However, while the utility of diagnosis continues to be debated, the impact of diagnosis on the therapeutic relationship has yet to be considered.The purpose of this research was twofold: to explore how working with diagnosed clients is experienced by counselling psychologists; and to formulate an explanatory theory of this process.This was a qualitative study using semi-structured interviews and a grounded theory methodology. Fourteen Chartered Counselling Psychologists and one Chartered Clinical Psychologist were interviewed about their experiences of working with diagnosed clients.Participants adopted one of three responses to diagnosis; ‘uncritically adopting diagnosis’, ‘challenging diagnosis’, and ‘compromising through pragmatic positioning’. Attempting to integrate the opposing paradigms of the counselling psychology philosophy and the medical model resulted in ideological dilemmas and uncertainty which compromised the therapeutic relationship and undermined the counselling psychologists’ professional identity.The process outlined in this study suggests that working with clients who have a psychiatric diagnosis creates uncertainty and ideological dilemmas. Clinical implications, limitations of the study, and suggestions for further research are discussed.