The biopsychosocial-spiritual model

Excerpted from the Preface to Treating Concurrent Disorders: A Guide for Counsellors - Approaching Concurrent Disorders

To help us understand the problems of people with concurrent disorders, we think in terms of the biological, psychological, social and spiritual factors involved in the emergence of these problems and—even more importantly—how these four vectors can become pathways to change and recovery.

For example, if a person has psychosis, or is severely depressed, medication works on the biological level to reduce symptoms. Another person, whose anxiety or anger causes out-of-control behaviours, might be able to manage better with cognitive-behavioural strategies learned in psychotherapy. For someone else, social issues may trigger distress or depression that could be improved with interpersonal therapy. And for another, spirituality can provide a pathway for recovery, as people who join 12-step fellowships such as Alcoholics Anonymous often report.

Our service has evolved in response to the needs of a set of clients in a particular urban and regional context. Over the past decade, we have committed ourselves to working with a heterogeneous client population, recognizing that outside our service there are no real options for integrated treatment for most clients with complex problems. Our treatment services have been determined by the real clients in our clinic, rather than by a theoretical model of concurrent disorders. Our inclination has been to accept all comers.

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