The Right To Be Diagnosed. Why Does A Psychologist Diagnose

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

I wrote a long text about the real world of psychological diagnostics. And then she took a pause and after a while decided that in this matter it was not worth going into directives, but the formula "forewarned - armed" would be enough so that everyone could draw their own conclusions and decide what was important to him and what was not. Thus, I simply state my point of view, formed by the described cases from practice.

From the very student days, many teachers at the university convey to students a very important message that the main difference between a psychologist and a doctor is that the psychologist does not prescribe medication and does not make a diagnosis. This was especially important when people knew practically nothing about psychologists and were afraid to contact them in the wake of "punitive psychiatry." Since the "conversational method" also takes place in psychiatry, it is the separation of oneself from medicine ("we do not heal") that has helped many psychologists to attract clients. But then confusion turned out, only doctors ceased to be psychotherapists and the term "therapy" had to be rehabilitated, while the diagnosis was not yet fully understood. And now, as never before, it requires clarification in the form "the psychologist does not make a medical diagnosis", since the diagnosis is just Old Greek. διάγνωσις, which means "recognition, determination". And by itself the formula "the psychologist does not make a diagnosis" only leads to the fact that some specialists really cease to carry out any diagnostics at all and often work not even according to "therapeutic experience", but simply on a whim, by a poke method.

Indeed, in fact, the formulation of a psychological diagnosis is one of the most important stages of starting work with a psychologist or psychotherapist. Since a person turns to a specialist in order to study or correct something specific, without identifying (not recognizing) this very "something" that really needs correction, and it is unlikely that it will be possible to correct it. The diagnosis of a psychologist and a psychotherapist may differ in essence. Studying a whole section of the science of "psychodiagnostics", the psychologist masters the skills of working with certain test methods, questionnaires and questionnaires, learns to put forward hypotheses and test them experimentally, etc. It is simply unrealistic to conduct any psychological research without diagnostics, since it is necessary to study and record the objective (and not "I believe") results of certain human properties "before" and "after" exposure. That is, translating into the plane of psychological correction, the psychologist has everything in order to suspect a problem, check his assumptions, choose the appropriate correction method and check its effectiveness (get a result).

Psychotherapists, on the other hand, place more emphasis on diagnostics in the framework of which they are trained and qualified as specialists. In any direction, in which the psychotherapist works, there is a concept of a norm (as is usually the case with most people), pathology (as it differs from the usual majority), the reasons for which this or that deviation occurs and methods of correction (how to fix what is "broken "if necessary and possible). For a more detailed study, you can enter the query "diagnostics in …" into the search engine, adding the direction that interests you. For example, I can cite diagnostics in the direction of TA (transactional analysis), which includes the study of the client's ego states, scenarios, hidden and destructive transactions, etc. or otherwise.

Often, various kinds of articles about borderline personalities, narcissists, neurotics are popular on the Internet, there are various classifications of addictions and codependencies, etc., but it is also important for readers to understand that these are not just words that unite some behavior, but they are real " diagnoses "made by a specialist. By the presence of symptoms, we may suspect that we have a particular psychological disorder, but this does not always mean that we actually have it. Increased anxiety, self-doubt and low self-esteem (it is still necessary to figure out whether it is underestimated)) can also be a subject for psychological research and correction. If a psychologist makes a conclusion, this does not mean that it will sound like a medical diagnosis, but any conclusion takes place precisely as a consequence of the diagnostic procedure.

In cases where a specialist does not carry out diagnostics, he essentially works with nothing, he just can listen, answer questions and that's it. If the purpose of contacting a psychologist is attention and support, then everything is in place. The solution to a specific problem is impossible without its identification, clarification and definition. In psychotherapy of psychosomatic disorders, the problem of diagnosis is especially acute, since often bodily diseases are a sublimation of cognitive disorders (a person cannot assess his condition objectively). Often there is anosognosia (in more detail in the next article), where blind adherence to the formula "all diseases are from the brain" and "diseases have spiritual causes and need to be treated by a psychologist", leads to the fact that people deny ("see, but do not notice") the presence of real clinical symptoms, and bring themselves to a complex somatic pathology or to major psychiatry. Therefore, first of all, it is important that a specialist in psychosomatics clearly distinguishes psychosomatic disorders from psychosomatic diseases, and everything connected with the difference between these processes.

As I promised at the beginning of the article, I will give more vivid examples from my practice, about how real, live psychological counseling and psychotherapy have changed my post-university understanding of the essence of the issue. These cases relate specifically to psychosomatic disorders, and not diseases, since it is much easier to appeal to a diagnosis for a somatic illness than for a disorder where it is difficult to "feel" anything.

Case 1 - after lengthy diagnostics and analysis, I explained to the client what was really happening to her, in what moments and how she was manipulating me, and what prognosis could be based on her condition. The reaction was something like "you are a terrible psychologist, you have no right to say such a thing, you inflicted an incurable mental trauma on me and you are worthless." Since when I started working, I was very picky about adherence to the consultation protocol, to standardized diagnostic methods, etc., I turned to former teachers for "supervision", and they explained to me that the psychologist does not make a diagnosis and the client does not come to him for a diagnosis. However, the psychological follow-up showed that the problem had actually moved to the intended level.

Situation 2 - after a while, another client came to me with quite obvious borderline personality disorder. Having the experience that "the psychologist does not make a diagnosis," I tried in every possible way to be understanding, accepting and helpful. However, in such a situation, work turned into a banal ping-pong, she manipulated me, I reflected her manipulations and tried to get to the bottom of what was hidden behind them. The work was exhausting, it did not bring any result, at some point I could not stand it, I decided to end the therapy and explained to her what was happening, why and how. The client said that she did not even think that her behavior "worked" in this way, she tried to behave differently several times, and after a while she wrote that everything was working out for her, that she was very grateful to me and glad that I "opened her eyes" … As a result, she really did a lot of work on herself, and learned to be more constructive in her status, because she already knew what she was working with.

Situation 3 - a few years later, a similar story repeated itself with the difference that the client was "psychologically literate" and I thought that since a person is so well-read in psychology, then he himself understands what his disorder is talking about. However, we did not succeed in solving the problem, since "well-read in psychology" and "psychologist" are not the same thing, as well as the distortion of the client's perception that I did not take into account due to borderline disorder. Despite the fact that the client thanked in words, it was obvious that she was not satisfied. Only at the end did I "dare" to recommend her work with a special psychologist, because a set of psychological disorders had a disappointing prognosis. Afterwards, I very much reproached myself for not discussing the diagnosis with her right away, perhaps if she understood what was really happening, she would have treated our interaction differently. This client did not give feedback after the therapy, and the case itself showed me that regardless of whether the client is ready to hear the diagnosis or not, he should be warned about what we see as specialists.

Situation 4 - the client is a man with a mental disorder. By that time, I already had sufficient experience with psychological disorders, so his behavior for me was a reflection of the mental pain that he was experiencing. I calmly reacted to his outbursts of rage (fortunately, we worked on Skype)), and the swings from accusations to apologies. The problem was that, unlike other clients with mental disorders who come to me with a ready-made diagnosis of a neurologist or psychiatrist, this one categorically refused to see a doctor. The very fact that I could diagnose him within the framework of clinical pathopsychology did not matter, because he denied the seriousness of the problem, made a claim that I was obliged to help him. I am a special psychologist, and a psychologist does not work with "psychos". His problem was partially solved, since what was of a physiological nature could not be corrected without medical intervention. However, I made an important conclusion that sometimes it is important not only to make a diagnosis, but also to record it in letters and messages.

This is due to the fact that I cannot be responsible for another person, while in the event of an unfavorable outcome, the first question to me will be “you haven’t seen what is happening to him, why didn’t you send him to the doctor?”. In our country, I am not protected by law in any way, and this practice has helped me a lot in other situations of working with depressed, suicidal clients. Especially demonstrative suicide. Abroad, there is even such a rule that when a client leaves therapy, the specialist reports this to the institution that sent the client in order to record the moment when the client is already outside the area of responsibility of the psychotherapist.

Why am I raising this issue?

Because, on the one hand, it is important for every non-specialist psychologist to remember that psychological diagnostics really exists, and in case of “strange” behavior and symptoms, or an emotionally “complex” history of the client, it should be carried out within the framework of the methods taught by a specialist in a university or a specific psychotherapeutic direction. On the other hand, if someone is confused about what is happening, you can always step aside and try to look at the problem from the very beginning - how it should be, what does not correspond, what is the reason and how to fix it. Each direction has this "plan". Perhaps someone will think "of course, it is easy for her to argue, she works at the interface with medicine and for her the diagnosis is routine." However, this is not entirely true, even if a person deals with problems of self-esteem, shyness, etc., we also examine his level of claims, anxiety, etc., in order to know what we will actually work with. Otherwise, everything runs the risk of turning into "I am scared - do not be afraid / I am insecure - you just need to believe in yourself / I will not make up my mind - And you just drop doubts", etc.)

I post a lot of publications of the famous psychotherapist J. Kottler about the so-called "Difficult Clients". They really exist and indeed psychotherapy with some of them turns into a test that does not cost any money for a person who works with his personality, his soul. However, it is important to remember that sometimes we, psychologists and psychotherapists, make our clients difficult by not recognizing what they are trying to convey to us with their "symptoms." There is always time for supervision, outside perspective, introspection and information for thought. Even if information that at first glance seems to contradict our qualification foundation.