Tuesday, December 28, 2010

Therapist Types: The One Diagnosis Wonder

Certain therapists become enamored with a particular diagnosis.  This one diagnosis becomes their professional obsession.  They become widely knowledgeable on the topic and proficient at diagnosing even latent and subtle manifestations of the chosen disorder.  Soon they are uncovering the disorder everywhere they look and in just about every client they see.  Besides providing the therapist with that Maslowian peak feeling that he or she has become a true expert in something, it also becomes quite lucrative and therefore a little difficult for the therapist to be truly objective.

Through the 1990’s and 2000’s the mental health industry relentless expanded its markets into new niches and populations that had never been tapped before, benefiting drug companies and therapists alike.  One of the ways this happened was through the promotion of “shadow” or “spectrum” syndromes.  These are mild versions of genuine psychiatric disorders.  Shadow syndromes have been identified for Attention Deficit Disorder (ADD), Autism, and Bipolar Disorder, among others.  The idea that some people manifest “sub-clinical” symptoms of these disorders is not new.  What is new is that some professionals now diagnose and treat people who present with these mild forms. 

This is one way in which the One Diagnosis Wonders get away with over-diagnosing their favorite disorder.  Another approach is the development of non-standard and unapproved diagnostic criteria that are broader than that given in the Diagnostic and Statistical Manual (DSM) of the APA.  One example of this is the currently popular “Complex PTSD” that allows counselors to semi-legitimately diagnose people with PTSD (Posttraumatic Stress Disorder) who do not meet the criteria for the official diagnosis as defined in the DSM.

Lastly, there are One Diagnosis Wonders who simply do not use careful or considered judgment in assessing and diagnosing.  These are therapists who diagnose from the hip and never give it a second thought.  Some may even disavow using the DSM criteria because they believe their expertise is so great, they can simply intuit that someone is afflicted with [insert favorite diagnosis].  This approach to diagnosing is particularly favored among the proponents of recovered memories and dissociative disorders (such as Multiple Personalities).

The problem with over-diagnosing is the simple fact that people are being labeled and treated, sometimes with medications, for a spurious or at least questionable diagnoses.  This can cause problems with side effects from psychiatric drugs (up to and including death), undue dependence on a therapist or the mental health system, and unnecessary labeling that can have an adverse effect on self-esteem, identity and personal development.

The One Diagnosis Wonder Symptom List
  • Many or most clients are diagnosed with the very same thing
  • The therapist seems to ignore, discount or minimize problems that don’t fit their favored diagnosis
  • The therapist pressures clients to accept they have symptoms or past experiences (such as childhood sexual abuse) even when the client denies these things.
  • Often these therapists will be good at talking and explaining their expert knowledge but don’t come off as very good listeners.

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