I finally jumped through one of the final hoops I need to get full licensure. This morning I took, and passed, the state licensing exam. I could have done this as soon as I finished school at the end of 2017, but I did not. I put it off. So, here I am, ready to be done with supervision, primed to strike out on my own.
Anyway, one of the questions I’ve encountered on the practice exams goes something like this: If your agency requires you diagnose a client, what are your alternatives? a) talk to your supervisor and tell her it’s against your ethics to diagnose someone b) talk to your colleagues and let them know you ethically can’t diagnose someone c) refuse to diagnose a client d) all of the above. The correct answer, apparently, is d) all of the above. As a counselor, ethically I am not to diagnose anyone.
I’ve been trained to diagnose using the DSM, or Diagnostical and Statistical Manual, a compendium of mental health disorders cataloging the signs and symptoms of everything from adjustment disorder to xenophobia, anxiety to trichotillomania. It’s not an activity I take lightly. People seek help with mental health because they are looking for ways to feel better, to combat the distress they are experiencing. I want to empower clients to improve their lives. I don’t want to overwhelm them with a label that carries negative connotations, a diagnosis that scares them or strips them of their power and self-efficacy.
Giving someone a diagnosis is a double-edged sword—a client’s DSM diagnosis allows them to seek services utilizing their health insurance. No one has to go bankrupt to afford mental health care. If providers get paid, clients can keep coming back, and not just to counselors in private practice, but also to community mental health agencies such as the crisis center I wrote about yesterday. The money we receive from insurance companies enables us to serve a wide variety of folks, many without the means to pay privately for anything, let alone mental health care.
But a diagnosis is also a label, and a mental health diagnosis can follow someone for life, influencing not only how they think about themselves, but how others might perceive them. We’ve made a lot of progress in the past few years to destigmatize mental illness, and many more people are seeking counseling as a matter of course. Being in therapy doesn’t carry the stigma it used to. But still. Perceptions linger and diagnosing (and thus labeling) a college freshman as bipolar can have lifelong consequences. They can begin to see each themselves as more illness than person, begin to limit themselves or be limited by others, including overprotective parents and well-meaning professionals.
I don’t want to give anyone a label that will hold them back in life. I want to help clients find ways to learn, love, and live their best lives, to understand what’s happening with their mental health, and I want them to be able to keep coming back, even if they can’t afford it. So, I have to give them a diagnosis if they use insurance to pay for counseling.
But, a diagnosis should only be a means to an end, not the final word on who anyone truly is or a limit on what they can achieve or who they can become.