Today’s post is all about labels. A big part of being a clinician is figuring out how much to use diagnostic labels in working with clients. Insurance companies say it’s absolutely necessary. Many mental health professionals say that you can’t treat an individual effectively without knowing their diagnosis. I tend to straddle the fence on this one – I’ll tell you why.
My inspiration for today’s post came from a post on Psychotherapy Brown Bag, an informative blog dealing with the application of research to clinical psychology, and the Time magazine article they cited (sorry for the link overload). Psychologists and other mental health professionals, like medical doctors, have a nice, thick book to guide us in making diagnoses. Ours is called the Diagnostic and Statistical Manual of Mental Disorders, and it’s currently on it’s fourth-and-a-half revision. The fifth revision, or DSM-V, is due out somewhere around 2012. Much of the discussion around the DSM-V centers on its shift from a categorical (all-or-nothing) system to more of a continuum model. In other words, instead of using concrete “you’re either depressed or you’re not” criteria, the DSM-V would allow for varying degrees of depression (or other issues).
But that’s not what I’m interested in today. I’m more interested in the use of labels, period – and how they impact the individuals who receive them. At times in my life, I’ve been relieved to get labeled. Often it’s been when I’m struggling with a medical issue of some sort and need someone to tell me that I’m not going to be sick forever. Another time it was comforting to have a physical therapist diagnose my knee pain and give me concrete strategies for helping it heal. But these were physical issues – discomfort that happened to me – rather than a mental health issue, which is much easier to interpret as coming from or caused by me. I’ve been very aware, during the times that I’ve used my insurance to see a therapist myself, of what diagnosis I would be given to justify continued treatment. Would it be Major Depression? Generalized Anxiety? Or the less “serious” Adjustment Disorder? Even though I cognitively know that there is always hope for change, the diagnosis carried a lot of meaning for me in terms of how “permanent” my symptoms were and what likelihood there was that I would feel better.
I see the full range of reactions to diagnosis in my clinical work – it’s a very personal matter. Which brings me back to my fence-straddling. About half of my practice involves evaluating kids and adults for learning and attention issues; these individuals (or their parents) come to me looking for a diagnosis. And I gladly provide it. Usually these diagnoses mean relief for the individual, a name for something that’s been bothering them for so long or keeping them from doing their best at work or school. For my college students, it means accommodations in school and legitimate documentation for medication.
But the individuals in the other half of my practice are usually less excited about a diagnosis. Those that I see for individual or couples therapy are often just wanting to feel better, and I’ve found that it’s less helpful to label them when they’re not necessarily looking for it. Now don’t get me wrong – I’ve seen some clients benefit from knowing that their symptoms have a name. For instance, a lot of men that I work with are glad to finally hear that they meet criteria for depression – almost like naming what they’re up against makes it easier to work on. I wish that this was the case with everyone, but it’s not. Just the other day a client told me about the experience of receiving a Borderline Personality Disorder diagnosis from a previous therapist. This particular client felt pigeon-holed and hurt that their person hood was somehow summed up in this one set of diagnostic criteria. So I usually hold back with sharing my thoughts on diagnostic info unless clients explicitly ask for it.
Thoughts, comments, and experiences are welcome as always.