Constructivist, categorial and dimensional approaches to client-therapist relationship: considerations, comparisons and implications in clinical context

Paolo Cappellotto

Associazione Italiana di Psicologia e Psicoterapia Costruttivista, Mestre, Venice (Italy)

Abstract
While the categorial (DSM IV and ICD 10) and dimensional (a set of symptoms and signs indicating and specifying an altered function) share the same basic epistemological vision of the man processing information (biological model of the brain working like a computer and realistic philosophical assumption), the constructivist approach (especially Kelly’s personal construct theory) is based upon a view of human knowledge as construction realities.

Is it possible to integrate in the clinical context all these approaches? Immediately, many cli-nicians would confirm their usefulness in clinical practice but the author of this paper (psy-chiatrist in private practice) suggests that a categorial approach has its advantages in epide-miology and scientific communication among health experts while the dimensional approach is relevant to a better disease-oriented psychopharmacology. Their common disadvantage is to see the psychological disorders in terms of entities and so reifying them and easy losing sight of the person behind the disorder.

Personal construct theory tries to understand the patient’s point of view in his personal con-struction of reality. The psychological dysfunctions are seen in terms of dimensions rather in terms of entities. If there is some compatibility between categorial and dimensional ap-proaches to the clinical use, not so with the constructivist approach based upon the person, not upon the diseases that affected him. „Differences that make a difference“.

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