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To Diagnose or Not to Diagnose?

Therapists and psychologists have their own beliefs about the concept of diagnosing. I would like to talk about mine.

Diagnosing is something that has become particularly important as the field of psychology has become more medicalized. Insurance companies require clinicians diagnose their clients prior to providing reimbursement. As a result, there is a certain degree of pressure for psychologists to come up with a correct and timely diagnosis – label – for clients. The concept diagnosing is stressed in most graduate programs, is considered standard practice by the American Psychological Association, and is believed to be necessary in understanding clients and psychopathology.

This way of thinking is especially hindering for a psychologist like myself who believes in understanding my clients’ experiences as unique and in a way that does not require judgment. I do not want to have to place my clients into any sort of category and treat them from the perspective of a “class” rather than as unique beings. Being pressured to categorize my clients into groups/labels/diagnoses reduces my understanding of the person. My focus in therapy and the way I relate to my clients is surely the opposite of putting them under a microscope and dissecting them to figure out the correct label as to what is wrong. Their experiences are so much more complex than that, just as anyone’s is. I whole heartedly believe therapy, growth, and reduction of symptoms can take place without the requirement of a diagnosis.

As a psychologist who also conducts psychological assessments, I do not want to portray that I never diagnose. Just like the insurance companies, there are other entities that require such labels. One such entity is academia. Most schools require that, in order to provide certain accommodations a child may need, a diagnosis is required. I suppose the belief is that this helps them to be able to better understand and help the child, as well as to come up with individualized accommodations. I personally believe that accommodations should come from understanding the child as an individual, not as a label. Nevertheless, this is how most institutions operate, and so we must adjust. Therefore I do provide diagnoses that will help the child to succeed, so long as the family wants to pursue this route.

Sometimes I have clients that feel having a diagnosis will help them to better understand themselves and what they are experiencing, will help them to change, etc. I fully support this and trust my clients in knowing what they need. This differs from mainstream views in that it is not me deciding for the client and forcing a diagnosis upon them. If a diagnosis is something they feel may benefit them, I am happy to provide an accurate one.

What I hope to convey is that I am not “anti-diagnosis.” I believe it is helpful to diagnose in many situations. I don’t, however, believe it is necessary in the way that I relate to my clients. It might be necessary according to a client of mine, in which case I would be happy to come up with a diagnosis that we believed to fit. I would be happy to provide one if it would help my client perform better in school, obtain a job, or something else that would enhance their life or that is required for them to succeed.

I worry that forcing a diagnosis could disempower a client. I believe this to be potentially harmful, and so I wish to relate to clients – people – in a different way. No, it’s not considered mainstream psychology and differs from the medical model. However, can the psychology of a person be medicalized? Can it be reduced to that? That might be a discussion for another blog!