Diagnosis: Is it necessary?

There has been some discourse among mental health professionals about if a diagnosis is necessary to treat our clients. Some are 100% against it, some are for it and some are somewhere in the middle.

Diagnosis as it is now is often necessary for insurance (in the US) for them to cover the cost of services and to prove medical necessity. It’s been my experience that most insurance companies only accept diagnoses that fall under the international classification of diseases (ICD) categories, which can use outdated terms as opposed to what the Diagnostic and Statistical Manual for mental illness (DSM) lists, which can make accurately reporting a diagnosis difficult. Both of these are an integral part of mental healthcare and really can serve as helpful tools to make sure our clients can get what they need.

For clients who are paying for mental health services without insurance, a diagnosis isn’t always necessary, since there is no one requiring it to pay for services.

For me, making a diagnosis helps provide a framework to use evidence based practices to work with my clients. However, I realize that both of those organizational bodies have a history of pathologizing cultural experience that hurts marginalized populations. I try to keep this in mind whenever I’m working with a client and a diagnosis is needed.

If a client wants a diagnosis or asks my thoughts on it, I let them know that diagnosis can be fluid and change over time, but I’m happy to walk them through what we would be looking for using the criteria from the DSM. Sometimes having the language to describe their experience helps to better cope with the symptoms, even if things that are causing their distress can’t be changed right away.

I’ve noticed that this has been particularly helpful for clients who come to be with a history of being diagnosed with ADHD before seeing me. This has helped us collaborate on ways to accommodate their symptoms at work or school and better understand how much of their life can be impacted by it. It’s helped change their inner thoughts of their abilities from things like calling themselves “lazy” or “stupid” to ‘I’m not lazy or stupid. I just need to look at the things I need to do differently than some of my peers”, which can go a long way in helping them feel better.

If a client doesn’t want a diagnosis for whatever reason, I help them to understand if/why it’s needed and work with them to find the least restrictive/stigmatizing one possible.

#counseling #mentalhealth #diagnosis #DSM #therapy #ICD #stigma