In the interest of empowering my clients, I always like to spend some time talking about what diagnosis is and what it isn’t and why I don’t do it as a regular part of my practice. Part of why I don’t accept insurance is because I dislike the dependency 3rd party payers have on diagnostic categories. Often they’ll refuse payment if your diagnosis isn’t adequate or your treatment is “taking too long.” Well, since I’ve never seen two different people with the same diagnosis that exactly matched their experience, I believe diagnosis has a limited usefulness in my work with clients.
First of all, mental health diagnosis is not like physical health diagnosis. I’m sure many of us have had our throat swabbed to see if our cough is from strep throat or bronchitis. At this point in history, there is no mental health equivalent of a throat swab to distinguish between anxiety, depression, bipolar disorder, or just too much crazy sh*t happening in your life. In order to arrive at a mental health diagnosis, a trained professional looks at the patterns in a client’s case and compares it to a list of symptoms in the DSM-IV. If the client’s symptoms fit the list, then bingo- diagnosis made. Only sometimes patterns don’t quite fit, or clients accidentally leave out significant information, or just plain don’t have enough information. So the label might not be quite right.
Secondly, diagnosis does indeed become a label. A label that might make one’s insurance premiums go up. A label that might limit your viewpoint of your life. A label that might become an excuse for poor behavior or social skills. And it might be the wrong label. Although sometimes labels are useful, and often when we’re struggling with a particular pattern, like depression or anxiety, it can be a huge relief to find out we’re not along in our suffering and there is help out there. So labels are good and bad.
Finally, I don’t think labels are necessary to do good work as a professional counselor. The DSM-IV is currently under revision, with loads of controversy. Likely many people’s official label will change when the DSM-V is ever finished. Within this reality, I still help clients address their “issues,” like abandonment, trauma, being the child of alcoholic/addict, becoming a mom or wife, solidifying an identity at work, or searching for their dreams and figuring out what “something more” means to them. All of these are important reasons to seek help – none of them require a diagnosis.