Presentation at the Global Summit for Alternatives to Diagnosis: This Summit doesn’t need to be reminded of the pitfalls and shortcomings of psychiatric diagnoses. But let’s not replace one expert-driven assessment of clients with another. Rather, I propose a system based on privileging the consumer’s voice about the nature of the concern and what is hoped to be changed derived from the client’s assessment of his or her major domains of life: personal well-being, interpersonal relationships, and social role functioning. With this as a starting point and continued client self-assessment, the consumer and the therapist collaboratively monitor progress, identifying when services are not working, and proactively seeking new directions when necessary. This system involves clients as full partners in all decisions that affect their care.
Client views of their progress is the foundation of therapeutic conversations, and their assessments of the alliance punctuate the discussion. With this transparency, PCOMS provides a mutually understood reference point for reasons for seeking service, progress, and engagement. Importantly, utilization of client feedback privileges the voices of clients over manuals and theories as well as other expert driven protocols, promoting idiosyncratic and culturally responsive intervention with diverse clientele. Client perspectives and perceptions, therefore, form the basis for service delivery including reimbursement.