Different Approaches: The Medical Model vs. Solution-Focused Therapy

Over the past 2-3 decades how people with mental health issues can be helped has been significantly changed. It is only with the better research methods, and better understandings of how the brain and mind work, that have allowed professionals to develop and grow new approaches to helping people with mental health, and here in this article specifically anxiety. Here are some of the differences that exist.

The medical model, which heavily influences traditional psychotherapy, views anxiety as a pathology, a problem to be diagnosed and treated. This approach focuses on identifying the nature of the problem, often through diagnosis, before intervening to reduce distress and suffering. The emphasis is on understanding the causes of anxiety, such as chemical imbalances, genetic predispositions, or past experiences, and then applying treatments, such as medication or problem-focused therapy, to alleviate symptoms.
In contrast, SFT shifts the focus away from the problem and towards the solution. It does not require diagnosing the problem before proceeding with treatment. Instead of focusing on the past and the problem, SFT directs attention to the future and the desired outcome.

Here’s a table summarising the key differences between the two approaches:

Feature	Medical Model	Solution-Focused Therapy
Focus	Past and problem-focused	Future and solution-focused
Diagnosis	Diagnosis before treatment	Stepped diagnosis (diagnosis is not a prerequisite for treatment)
Emotions	Focus on negative emotions	Focus on positive emotions while acknowledging negative ones
Theory of Change	Therapist’s theory of change	Client’s theory of change
Conversations	About the problem and what the patient doesn’t want	About what the client wants to have instead of the problem
View of the Client	Deficit model: The patient is viewed as damaged. Focus on how anxiety affects them.	Resource model: The client is viewed as influenced but not damaged, possessing strengths and resources. Focus on the client’s response to anxiety.
Motivation	Patients are sometimes viewed as unmotivated (resistance).	Clients are viewed as always motivated, though their goals may differ from the therapist’s goals.
Goal	Reducing problems and negative affect.	Goals are individualised for each client; increasing positive affect may be a goal.
Therapist’s Role	The therapist is the expert, provides advice and may confront.	The therapist asks questions to elicit the client’s expertise, accepting their view and asking, “How is that helpful?”
Treatment Length	Often long-term	Variable/individualised length of treatment

While the medical model aims to recover from anxiety, which could be considered an avoidance goal, SFT focuses on helping clients achieve what they want instead of anxiety, an approach goal.

Importantly SFT doesn’t completely reject the medical model. SFT can be used in conjunction with biological treatments like medication. In such cases, SFT can help clients envision a positive future with the medication’s support and identify ways to enhance the medication’s effects.

John Nolan