Beware of unofficial diagnoses & double meanings

Some terms used by therapists to describe clients have meanings which won’t be found in textbooks. Use of these terms is rarely of benefit to the client, although the term may say as much about the therapist as the client.

  • resistant to treatment
  • lacking motivation
  • poor historian
  • manipulative
  • demanding
  • somatising
  • chaotic
  • personality disordered

As diagnostic systems have developed, common place words have been redefined more narrowly & precisely for clinical use (eg: anxiety, depression).

As therapeutic professions have developed, there has been a less auspicious development: diagnostic labels have developed double meanings and common place words have been elevated to the level of diagnoses without the scientific scrutiny afforded official classifications.

A diagnosis is a therapist’s shorthand. The idea is that a single label will tell you not only the client’s current symptoms but also how they can be expected to change over time and what is the most effective treatment. Diagnostic systems such as the World Health Organisation’s International Classification of Diseases (ICD) and the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM) are employed across the world.

Unofficial diagnoses also indicate how the client is perceived by their therapist and may dictate how the client’s treatment will proceed (if at all). As these definitions are unwritten, this information is not available to clients.

Many therapists reject these cynical re-interpretations. The misuse of these labels says much about a therapist’s biases and prejudices. Moreover, the perceptions and judgements that lead to their misuse probably say as much about the client’s experience of the therapist as they do about the client.

Diagnoses with double meanings create scope for confusion and poor practice:

  • a diagnostic label applied objectively may be interpreted more cynically by other therapists, to the detriment of the client
  • a label applied dismissively may be taken at face value by other therapists to the detriment of the client and the service
  • therapists may collude in the cynical use of a label, to the detriment of all clients so labelled

How many of the above labels do you use and how certain are you that your colleagues share your interpretation of them?

One thought on “Beware of unofficial diagnoses & double meanings

  1. ive used a few. they are secret code in the conceptualization. although i must say that an experienced therapist should be able to draw hypotheses based on some of those views and hopefully lead them to a fuller understanding.

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