To Diagnose or Not To Diagnose?

When beginning therapy, you probably expect to receive a diagnosis.  Sometimes, people even want one to better understand what they are going through.  Though sometimes people fear a diagnosis and its potential impact on their life and relationships.  What if I told you, you don’t have to have a diagnosis when you go to counseling? “LIES!” you might think.  But it’s absolutely true! If you see a therapist and pay privately, a diagnosis is not required. It’s one of the benefits of private pay.  But how do you know if this is right for you? What are some of the positives and negatives to having a diagnosis?

A diagnosis can be an important part of mental health.  It’s required for insurance companies to reimburse therapists for sessions.  However, reimbursements will only be issued for certain diagnoses and therapeutic interventions/modalities which vary by company.  In addition, diagnosis is important for receiving benefits and services such as disability, school accommodations, and special programs.  Furthermore, this can help guide treatment and have the client feel understood. Finally, its a quick and easy way for different practitioners, like doctors, psychiatrists, counselors, etc. to communicate which is important for the client’s care.

However, diagnosis is the act of a person other than the client who is experiencing the problem, telling the client what is wrong with them.  It’s labeling them based on generalizations rather than their unique experience of the problem. It’s claiming to be an expert on an issue of which that person is not experiencing.  In a way, this takes away from the client’s expertise on their life and what they go through. After all, the therapist or doctor isn’t following that person around all day to understand what “anxiety” or “depression” is like for the client.  I don’t know about you, but I barely have time for my own life, let alone following someone else’s all day! Since this other person cannot fully understand your symptoms and diagnosis is somewhat subjective you may run the risk of misdiagnosis which could interfere with treatment, and thus not receive the treatment needed.

You could argue with me about the definition, but we can all agree diagnosis labels something. This act of labeling someone could do more harm than good.  It can make them feel helpless, hopeless, or to blame for their mental/relational/life struggles. It might kick the fight out of them, believing this is who they are and that they have no power to change that.  Brené Brown writes in her book Daring Greatly:  How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent, and Lead, “Diagnosing and labeling people whose struggles are more environmental or learned than genetic or organic is often far more detrimental to healing or change than it is helpful.”  I’d even argue that when diagnosing organic struggles you run the risk of preventing healing. For this reason, I always remind clients that what you are experiencing is NOT a flaw in character, but a challenge to overcome.

Receiving a diagnosis may also come with some unforeseen consequences, such as being denied life insurance or needing to pay higher premiums because you are a bigger risk.  They may prevent you from gaining employment in certain jobs or receive certain licenses. In addition, they carry a stigma which could lead to unfavorable treatment or misunderstanding by others such as friends, family members, co-workers, employers, etc.  Therefore, a diagnosis has the potential to impact multiple areas of a client’s life.

I’ll be honest with you, I’m not a fan of diagnosis and prefer not to diagnose my clients (thought I know at times it is necessary and helpful).  I hold so firmly to the Narrative Therapy idea that “people are not problems, problems are problems” that I often forget what diagnosis my clients have and will have to go back in the notes to remember.  While I work on the symptoms, struggles, and challenges each client comes to session with, what the diagnostic label derived from the DSM is often irrelevant. What is more important to me is the label or name the client gives their problem.  Its unique to them and their situation, and thus solutions are unique as well. I work with them to overcome their unique problem in a unique way because they are a unique person. When this happens there is more freedom, confidence, and creativity within the sessions; something I love when working with clients.

It’s important to remember that not all diagnoses are bad and not all of them carry negative connotations.  However, diagnosis should be part of the discussion you have with your therapist, especially if you have questions or concerns related to your mental health care.  You know you, and what you need.  Diagnosis does not erase that.

Check out these articles for more info on pros and cons of diagnosis and on receiving a diagnosis.