Diagnoses of particular mental health disorders can be very useful in the process of therapy. They often provide both the client and the therapist with helpful language that can be used to describe thoughts, feelings, behaviors and habits with more precision than would be otherwise possible. The diagnosis may represent an accurate, perceptive account of part of a person's psychological life. 

In addition, a diagnosis can be comforting to the person who feels bewildered and maybe 'unusual' as a result of the way her mind works. Many individuals are relieved to learn that the thing that is troubling them has a name, has been dealt with by others, and is not as uncommon as they might have thought.  

On the other hand, there are ways of dealing with diagnoses that can be unhelpful. Here are some ways I think this can be true.  

While a diagnosis may cast light on a person's psychological circumstances, it may also serve not as an aid to careful thinking, but as a replacement for it— we may look at a label instead of a person.  When we say, 'I am a ______', or 'that is typical of ____' , without looking more directly at feelings, behaviors, circumstances, or individuality,  we may be reducing or simplifying.   It can be tempting to stick to the label as a substitute for more patient and nuanced observation.  

In therapy, I try to manage this in the following simple way: when someone says that he has a particular mental health disorder, I ask what he thinks about it, what it actually looks like, how it effects him concretely, what it is that feels unmanageable. I also want to know if the client has a sense of stigma from the diagnosis— if so, this can be an important thing to discuss.  I also like to find out when and how he received the diagnosis, and if it makes sense to him.  

I ask this last bit because I fear that diagnoses can be made hastily, after a very short assessment.  In some cases, the one doing the diagnosing hears a few words or spots a few signs that suggest a 'disorder' that may not have been indicated with different questions, or by allowing the client a few more sentences of explanation. In addition, a mental health professional may have a particular hammer that she likes to wield, causing many things to look like just the nail that she is on the lookout for.   Accurate diagnosis is also complicated by the ways that mental health problems can resemble one another or overlap.

With diagnosis as with many things in therapy, it is important to remain open-minded, and to maintain an experimental and flexible attitude.  This way we can keep the benefits that come through identifying mental health 'disorders’, seeing states of mind ‘through’ them without their becoming walls that obstruct our perception. 

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The author, David Kohanyi, LMFT, is currently accepting new clients and can be reached at 619-272-6858 x710 or david@anxietytraumatherapy.com

David is also facilitating an Eating Disorder Support Group staring March 6th, 2017 as well as continuing to co-facilitate an ongoing Anxiety and Depression Support Group. Please feel free to contact him if you are interested in participating in either of these two groups. We look forward to connecting with you!