The Role of Diagnosis in Therapy

If it’s your first time going to therapy, you may be wondering if your therapist is going to give you a diagnosis. Many people going to therapy may have never seen a mental health professional before. Some people may find that discovering their diagnosis is freeing and makes them feel less alone. Others may not care as much. But first, what is a diagnosis in therapy and what role does it serve for you?

What a Diagnosis Is

A diagnosis is a snapshot of the problems you present for therapy. Dr. Virginia Boga, a New York licensed psychotherapist explains, “A diagnosis provides a label to the symptoms a patient experiences.” For example, a diagnosis of depression may be made if you report you’ve lost interest in your usual activities or have been feeling down about yourself.

A diagnosis can change over time as your therapist gets to know you better and hears your concerns. This may be over the course of multiple intake sessions. Before going to therapy, your therapist may get an initial history from you by having you fill out forms with several questions related to your mental health background. They may also have you complete different screening questionnaires to help determine your level of anxiety or depression.

Mental health professionals use a book of diagnoses called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to help them determine your diagnosis. This book helps categorize your symptoms to determine what your diagnosis is. An accurate diagnosis can help tailor the course of your treatment and is important in order for you to receive the treatment you need.

The Limits of Diagnosis

At its heart, a diagnosis is designed to be a key that helps you access the support you need. Therapists and other healthcare providers act as locksmiths, using their experience, education, and discretion to help you thrive.

Self-diagnosis, while different, is another valid tool for accessing the information and language you need to advance your care.

Diagnosis has many pitfalls. When a diagnosis is oversimplified or applied inappropriately, it can end up harming your care more than helping it.

Self-fulfilling prophecies

A diagnosis should inform treatment, not directly influence it. A risk of diagnosis is that, once a person receives a diagnosis, they are more prone to behave in a way that confirms it.

Similarly, even the best-intentioned therapists may begin to view their patient through the narrow lens of that condition, closing them off from context that might be important for treatment.

Reification

Reification is the perception of a mental health condition existing independently, beyond the psychologist’s diagnostic conceptualization. In reality, a diagnosis is merely a hypothetical construct that is created to describe a group of behaviors that co-occur.

So, in short, a person is not their diagnosis. Instead, they may suffer from certain behaviors that reduce their ability to function.

Condition confusion

The DSM-5 offers a foundation for consistently applying diagnoses. It is, at its core, a helpful simplification of various mental health care experiences.

Most people diagnosed with a mental health condition will be diagnosed with others over the course of their life. This describes the idea of comorbidity; that some conditions may occur simultaneously, and that some behaviors could reflect more than one diagnosis.

When a diagnosis weighs too heavily in treatment, it can prevent the therapist from providing context-aware, holistic, and multimodal care. And, it can even cause misdiagnosis.

What a Therapist Uses a Diagnosis For

Therapists use a diagnosis for multiple purposes. A diagnosis helps them track your progress and determine if you need to be referred to a psychiatrist for medication. “A diagnosis provides a clinician with a guide for treatment,” Dr. Boga says. Most insurance companies require a diagnosis in order to receive reimbursement. To that end; diagnosis is simultaneously important to billing, treatment, and (for the therapist) compliance.

If your therapist refers you to a psychiatrist, it can be helpful for them to share their diagnosis with the physician to get a second opinion and explain where you are in the course of your treatment in therapy. If the psychiatrist disagrees with your therapist’s diagnosis, they may have a conversation about the concerns you are presenting with to help determine the most accurate diagnosis that will help you get the treatment you need.

Therapists also use a diagnosis to help you if you need to apply for disability or job protection. A formal diagnosis is usually necessary to apply for Social Security benefits or job security under the Americans with Disabilities Act. Similarly, if you are applying for long or short-term disability, your insurance company will want a record of your diagnosis from your therapist.

Do You Need a Diagnosis to See a Therapist

If you’ve never seen a therapist before, it’s not necessary to have a pre-existing diagnosis before going into your appointment. Some therapists practice non-diagnostic therapy that focuses on the whole person rather than a set of symptoms. You don’t need to believe you have a formal mental health diagnosis to see a therapist. For example, some people may see a therapist after a divorce or loss of a spouse.

“In order to see a therapist, a diagnosis is not mandatory unless you are using insurance. Insurance panels only reimburse with a diagnosis and some are even specific to which diagnoses they cover,” Dr. Boga explains.

While it’s your therapist's job to provide a diagnosis, it’s important to be as honest as possible when explaining what brought you to therapy. Some tips to help you be the best advocate for yourself are:

• Ask a close friend or family member for input on your symptoms
• Try to provide an objective measure of your symptoms such as rating them 0 through 10
• Speak up if you disagree with something in your treatment plan
• Track your progress and let your therapist know if you experience any new symptoms

Your therapist may give you specific exercises to do, worksheets to fill out, or books or articles to read as part of your treatment plan. Even if you do not receive a formal diagnosis, your therapist may still want you to do this type of work to help you in feeling better.

Should I Ask for My Diagnosis

For some people, knowing their diagnosis can be validating and make them feel they are part of a collective group with other people who share their diagnosis. For others, a diagnosis may cause additional stress and worry. So the question is, “Should I ask my therapist for my diagnosis?”

Unless you ask, your therapist may not come out and tell you what your diagnosis is. Under certain circumstances, such as if you are in a serious mental health crisis, your therapist may express their opinion or consult with a physician for a medication referral. But otherwise, your therapist may keep your diagnosis to themselves in case you don’t want to know what it is.

Some people may not want to know their diagnosis for fear of being labeled or judged. While your therapist will not judge you for your diagnosis, some people may fear others will if they share their diagnosis. Mental health is still very stigmatized and some conditions, unfortunately, carry more of a negative stigma than others. Still, there can be some benefit to knowing your diagnosis.

Ultimately, having an accurate diagnosis will help you get the proper treatment you need. Whether you want to know your diagnosis or not, putting a so-called label on the symptoms can help make sure you’re on the right path to feeling better. It can also help point you in the direction of valuable resources and support.

What if My Diagnosis is Incorrect

Misdiagnosis unfortunately happens. Some conditions, such as borderline personality disorder, are more likely than other conditions to be misdiagnosed. When this happens, it can help to get a second opinion from another therapist or a psychiatrist if you have one. You can also address it with your therapist by letting them know if you feel your treatment isn’t working or your symptoms are not improving.

Dr. Boga explains, “Diagnosing is a work in progress. When a clinician first meets a patient, that is the first glimpse of them. But as the therapeutic relationship develops, new issues come to surface and the clinician could have a much better understanding of their patient leading to changing the diagnosis.”

Usually therapists have a formal diagnostic procedure in place to make sure they are assessing your symptoms accurately. You may also want to ask yourself some questions to be sure your therapist is taking the right amount of care when interviewing you, such as:

• Does my therapist accept everything I say or ask follow-up questions?
• Do I feel rushed in our appointments?
• Does my therapist (with my permission) ask for information from close family members or my significant other?
• Do I feel comfortable sharing my thoughts and opinions?
• Does my therapist collaborate with my other treatment providers?

Ultimately, no matter what your diagnosis may be, your therapist is going to treat the symptoms you present with. Your diagnosis provides a label of what your symptoms represent. If you feel your diagnosis is not an accurate portrayal of your symptoms, speak up about it to your therapist or get a second opinion. Getting an accurate diagnosis not only helps in your treatment plan but can empower you with language that articulates your experience.