One of the primary reasons people become motivated to seek out therapy is due to some friction in their lives—in some unique way(s) to that individual, their experience is out of sync with their expectations, leading to anxiety and depression.

There is often an element of powerlessness, and, to gain some power in the situation, we tend to look for the problem in ourselves. Our culture in the U.S. has normalized in that there is something wrong with us that needs to be fixed, that we need some product or another, that we need to lose weight, or that we need to deny our experience in some way.

Exploring diagnoses in psychotherapy can be valuable to a client because realizing there is language for our experiences is an important process in understanding ourselves and feeling like there are others who also experience this. It becomes an avenue for exploration and connection.

The Danger of Self-Diagnosis

In this context, it makes sense that many clients are interested in getting a diagnosis from their therapist to know what is wrong and can fix it. The drive to find the problem in themselves is so strong that many people even resort to TikTok to diagnose themselves.

While those approaches may work when a car isn’t running well, humans are far more complex. In fact, top neuroscience researchers admit that they don’t even know the basics of how our brains work. Furthermore, research from the National Institutes of Health (NIH) shows that the “reliability and validity of psychiatric diagnoses have always been a major concern.”

Neither mental health professionals nor primary care doctors effectively provide accurate diagnoses. In fact, primary care providers have been shown to be 0% accurate at diagnosing psychosis!

The Problem of Diagnosis

A diagnosis is a snapshot at a point in time by a professional who may not have spent much time with the client. Diagnostic criteria are based upon observations by the professional, not the inner experience of the client. It doesn’t take into account the power dynamics of diagnosis—what does the client consider problematic, and how does the client make sense of what’s happening to them.

Has the professional had training in differential diagnosis among various possible explanations for what they observe? Do they know how to differentiate between ADHD and borderline personality in women?

How do their biases impact their diagnoses (- a Black man may be more likely to be diagnosed with Schizophrenia than a white man). ? To what extent do they understand the impact of neurodiversity and complex trauma and how they show up in an individual?

There are plenty of other ways diagnoses, and even the DSM itself, are problematic.

My Approach

In my practice, I typically opt out of diagnosing clients unless it is a collaborative effort toward a particular purpose. I do my best to make sure that clients understand the nature of the diagnosis and to ensure a fully informed choice by the client about how to communicate their internal and external experiences.

I would even go so far as to say that the path of psychotherapy without a diagnosis in a collaborative process with a therapist is likely to be more effective – only because the therapy is much more likely to be specific to the client’s unique internal and external patterns, skill development opportunities, values, and goals.

Take a plant for a simplified example; plants in general have certain specific needs including sunlight, moisture, nutrients such as pollen which may vary from species to species and plant to plant. When I have a plant that is not thriving in my house, I may look up the needs for that species, then meet those needs. I pay attention to the way the plant responds to these changes and that helps me get to know the specific plant and gradually refine the way I nourish that plant.

A similar process occurs in therapy. For instance, I know that for healthy development of the Self, we need to feel valued and admired, identify heroes to learn from, and experience a sense of belonging  and connectedness. By beginning with these key nutrients for the human psyche, we can then learn more and more through a collaborative refinement. This is highly simplified of course.

There are many therapeutic theories, processes, and skills, yet certain common factors have been identified that some believe are the actual mechanisms for growth and development in therapy. Furthermore, there are many therapeutic styles and interventions that are trans-diagnostic, in other words they are not dependent upon a DSM diagnosis.

Reflecting on What a Diagnosis Means for You

As you consider personal growth through psychotherapy, I encourage you to consider whether a diagnosis is important to you. You may find that shifting your perspective from locating the problem to your exploring your unique path forward through new skills, new patterns, and new perspectives. This is where you will find the center of you.

Book a Consultation

You may book a 20-minute consultation with me as a first step to joining our intensive 12-week therapy program, or drop me a message anytime when you just want to talk about new experiences in your life.