Using the CPCAB model to address Common Mental Health Problems
Your GP and other trained clinicians use ‘The Medical Model’ when looking at Common Mental Health Problems (CMHP). Their focus is on the dysfunction in their patient and the correct diagnosis. They problem-solve to treat any biological and physical aspects of the disease. The process is informed by scientific evidence, GP advice and interventions for health improvement.
Psychiatrists also use the medical model to improve and validate bio-psychosocial psychiatric medicine. Neuroscience continues to investigate the brain and the mind.
Counselling was originally formed in the 1940s as a direct challenge to The Medical Model as it was back then, which was seen as ‘reducing the patient to symptoms‘ and ‘did not include context‘. Counselling provided an alternative ‘whole system’ approach which included client problems, client change and supporting that change.
According to research 80% of clients seeking counselling today are not ready to make change and are instead at the ‘pre-contemplation stage’.
Therefore before change people need time to explore how their problems arise and how they are connected to themselves and their lives. Counsellors can support this by listening to clients explore their thoughts, problems and self beliefs helping to develop more insights and self awareness which can lead to making change.
The Counselling and Psychotherapy Central Awarding Body (CPCAB) developed ‘The CPCAB model’ in the 1980’s and is now used by counsellors and psychotherapists firstly in their training and then later in their work with clients. The CPCAB model supports client change by considering treatment factors, but also considering context factors such as the client, the counsellor and the client-counsellor relationship formed. People are referred to as clients not patients to indicate an equal relationship and the responsibility for well-being is placed with the clients not the counsellor.
The Three Dimensions to Problems:
Problems rarely exist in isolation, so someone who initially comes into counselling with the goal of stopping smoking (Service Level A), realises later that smoking calms their social anxiety (Service Level B). Smoking is therefore a coping mechanism not the problem. It is not wise to remove a coping mechanism without either another in place, or addressing the root problem. The goal may then be to explore the underlying cause of social anxiety and to express those feelings. If a coping mechanism was still required to support anxiety, healthier alternatives could be explored.
The Three Levels of Client Problems/Client Change:
Service Level A: Life Problems (e.g. divorce, bereavement, work stress)/Changing the way to cope with life problems
Service Level B: CMHP (e.g. Anxiety, Depression)/Changing aspects of self both explicitly and implicitly. Sometimes the problem is not ‘out there’ but within ourselves. Sometimes goal setting can be helpful at the explicit level but on an implicit level it may require looking at three dimensions of change:
Service Level C: Severe and Complex CMHP (e.g. psychosis)/Changing aspects of the foundations of self. Foundations are developed during childhood and involve experiences which shape our sense of being in the world. As with Service Level B clients, it may be helpful to look at the three dimensions of change. It is important to recognise that a referral to GP/psychiatry for clinical support is necessary for issues at this level, although a senior counsellor (with further training and experience) can support alongside psychiatry.