Many clinicians who are working in the systems are set up to not have all the information. In the three states I’ve worked in, I’ve never heard of a public agency that pays for diagnostic tools anyway—so I know I’m talking to clients that have often landed diagnoses without ever having undergone any diagnostic testing. And while I’m familiar enough with the criteria for many diagnoses that I have them memorized, most of my trainings have focused on symptom treatment, not diagnosing. For example, while DBT is designed to treat borderline personality disorder, its administration is taught to address particular symptoms that are self-evident in the skill descriptions: emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness. When I use DBT, it’s because I’m addressing a need in that particular area, not because I’ve bestowed a diagnosis on the person in front of me. Here are 5 steps that clinicians can use to talk with clients about diagnoses.
Look at the history (with a handful of salt)
I would not only look at what diagnoses the client received, but when, how long and by whom. Did they get a borderline personality diagnosis after 24 hours in a hospital but none of their therapists have ever indicated anything like it? Hmmm…
Share the history with the client and ask them what they think
I absolutely believe it’s the client’s right to know their diagnoses, but it is amazing how often they don’t know what they are. So we go over:
Do they know what they’ve been diagnosed with?
Also, do they know what it means? If they want to know, I break it down for them in laymen’s terms.
Do they agree with them? Most people want to understand what they’re diagnosed with, and have an opinion about what’s bothering them.
What has their treatment looked like in the past? This is to see if they’ve gotten treatment that looks anything like a recommended treatment for their diagnosis. For example, a client whose been treated for a panic disorder should have at least heard of breathing and grounding exercises.
Talk with the client about their current symptoms and medications
What’s their current experience? How are they managing the diagnoses that are on paper?
Ask about a history of trauma
I’ll admit that before I became a trauma specialist, I didn’t do this one every time. But now that I have this lens, I can never un-see the relationship that trauma has with both psychological and medical symptoms. Don’t request details, since that’s not okay to do in an intake, but just a “do any of these sound familiar” can yield valuable information.
Reflect back and contextualize
Clients can give you a narrative of their experience. It’s my job to convert that into symptoms. This isn’t always easy, but that’s why I can check back “I heard you say that you’re worried that you’re being recorded here, and that this a concern that happens a lot. I’m guessing you feel unsafe a lot?” Now I know that this person may have some paranoia—and their history may help me figure out whether it’s because they are hypervigilant from complex trauma or whether they have a psychotic illness or it’s a psychotic symptom in a mood disorder, whether they might be under the influence of medication or they’re in an abusive relationship where they are being followed and recorded.
Empowerment is about transparency. It’s about communicating what I’ve heard. It’s about willing to take the side of the client even if that means disagreeing with professionals.