{"id":507,"date":"2018-03-12T15:15:19","date_gmt":"2018-03-12T15:15:19","guid":{"rendered":"http:\/\/www.normanclaringbull.co.uk\/?p=507"},"modified":"2018-03-12T15:15:19","modified_gmt":"2018-03-12T15:15:19","slug":"blog-post-spring-2018","status":"publish","type":"post","link":"https:\/\/normanclaringbull.onplexaweb.co.uk\/index.php\/2018\/03\/12\/blog-post-spring-2018\/","title":{"rendered":"BLOG POST – Spring 2018"},"content":{"rendered":"

DIAGNOSIS\u2026 A SHOT IN THE DARK:<\/p>\n

All therapists diagnose their patients \u2013 even those of us who claim that they never do. We have to. How can we help our clients if we don\u2019t know what their problems are? Some of us label our patients deliberately and use those labels as guides to treatment choices. Others of us, perhaps without realising it, implicitly label our patients if we usually adhere to a particular treatment approach\"\", (usually the one in which we were first trained). After all, every school of psychotherapy has its own unique beliefs about the origins of its patients\u2019 distress \u2013 that\u2019s labelling by default. So, it\u2019s not a question of \u2018should we diagnose\u2019? Diagnosis is unavoidable. The real question is, \u2018how can we minimise any harm that might come about when we do so\u2019?<\/p>\n

Strictly speaking, diagnosis is a medical term and should only be used by medical practitioners. What psychotherapists do are assessments, (in practice it\u2019s the same thing). I have written extensively about psychotherapeutic assessment in my book \u2018Mental Health in Counselling and Psychotherapy\u2019, (www.amazon.co.uk\/Mental-Health-Counselling-Psychotherapy-Practice\/dp\/0857253778<\/a>). I\u2019ve even included a \u2018How To Assess Guide\u2019. Why not have a look?<\/p>\n

Whether we are assessing, (or diagnosing), our clients, it is important to remember that our conclusions are always simply a collection of personal judgements. They are nothing more than our best guesses at the time. There are no objective tests in psychiatric or psychotherapeutic diagnosis. You can\u2019t take a patients \u2018psychiatric temperature\u2019 nor can you measure someone\u2019s \u2018emotional blood levels\u2019. Not only that, but experience shows that no psychological diagnosis is reliably predictive. You cannot confidently say that \u2018Mental Condition A\u2019 will result in \u2018Abnormal Behaviour Type 1\u2019. What makes our assessments even more \u2018fuzzy edged\u2019 is that mental health diagnosis is carried out on a \u2018menu\u2019 basis. For any given condition, an \u2018a la carte\u2019 list of symptoms is provided. The more positives scored, the more likely it will be concluded that a patient has that particular condition. Menu-based diagnostic systems generate two major problems. Firstly, deciding on a \u2018positive\u2019 is a matter of opinion. Are our opinions soundly based? Secondly, because many of the symptoms on any given list are also found in the lists for other mental health conditions, we have to be sure that we are working with the right list to begin with. The imprecise nature of mental health diagnosis is further highlighted by the option to diagnose \u2018Not Otherwise Specified\u2019 for most of the psychological disorders. That diagnosis is best translated as \u2018we know you\u2019ve got it but we can\u2019t prove it!\u2019<\/p>\n

So, given all the uncertainties, should we assess our patients? My answer is a firm \u2018Yes\u2019 because our best guesses, backed up by clinical experience, are very often correct. In any case, what else have we got to work with?\u00a0 I also say \u2018Yes\u2019 because appropriately tailored therapy packages can help our clients and inappropriately tailored ones can harm them. Take for example a patient suffering from one of the trauma-related conditions. In those cases, specific therapy styles such as CBT, EMDR, or DBE are often helpful. Non-directional standard counselling is at best useless, and at worst, a source of re-traumatisation. Assessment helps us to make better choices about our patients\u2019 therapeutic needs.<\/p>\n

Psychotherapeutic assessment is not something to be carried out by the untrained or the inexperienced. That\u2019s because the very first thing to do, is to find out whether or not a presented set of symptoms indicates a physiological or a psychological disorder. For example, a patient presenting with what at first sight appears to be severe anxiety might actually have abnormal coronary or thyroid activity. Equally, a patient who has been prescribed beta-blockers by a GP for what seems to be a heart rhythm problem might actually be suffering from a psychosomatic condition. Sensible psychological assessors follow a simple rule \u2013 \u2018if in doubt, get it checked out\u2019! Sensible psychotherapists and sensible medics co-operate and support each other. It\u2019s not \u2018medicine OR psychotherapy\u2019, it\u2019s \u2018medicine AND psychotherapy.<\/p>\n

The next thing to do is to not let your initial patient labelling put blinkers on you. Over any course of psychological treatments, diagnoses can, (and should), vary as new symptoms emerge and old symptoms fade away. This means your initial diagnosis must be under constant review and so must your treatment strategies. Flexibility is the name of the game!<\/p>\n

Next, when treatment planning always consider the pros and cons of any given therapeutic method. Don\u2019t be blinded by the \u2018one size fits all\u2019 approaches offered by the traditional psychotherapies. Any of the main schools of psychotherapy, (humanistic, analytical, cognitive-behavioural, and their many sub-divisions), can be helpful or harmful, depending on circumstances. The most important assessment decision of all is deciding which treatment method, (or mixture of treatment methods), is best for which client and at which time during the therapeutic process.<\/p>\n

There is a final point to bear in mind when diagnosing or assessing a patient. Labels tend to get fixed. It they get noted in official records then this can affect, distort even, a person\u2019s whole life. The danger is that everybody will stop seeing the person and only see the label. Not only that, although obviously a convenient form of professional shorthand, labels all too often are very much misunderstood, even within the helping professions. So be careful how you use diagnostic labelling and be very careful about letting others know about your diagnostic conclusions. Above all, use assessment as a therapeutic aid; don\u2019t let it take over the show.<\/p>\n","protected":false},"excerpt":{"rendered":"

DIAGNOSIS\u2026 A SHOT IN THE DARK: All therapists diagnose their patients \u2013 even those of us who claim that they never do. We have to. How can we help our clients if we don\u2019t know what their problems are? Some of us label our patients deliberately and use those labels as guides to treatment choices. […]<\/p>\n","protected":false},"author":1,"featured_media":480,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"wpm_timeformat":"","_wpm_styles":"","footnotes":""},"categories":[2],"tags":[],"class_list":["post-507","post","type-post","status-publish","format-standard","hentry","category-blog"],"yoast_head":"\nBLOG POST - Spring 2018 - Norman Claringbull<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/normanclaringbull.onplexaweb.co.uk\/index.php\/2018\/03\/12\/blog-post-spring-2018\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"BLOG POST - Spring 2018 - Norman Claringbull\" \/>\n<meta property=\"og:description\" content=\"DIAGNOSIS\u2026 A SHOT IN THE DARK: All therapists diagnose their patients \u2013 even those of us who claim that they never do. 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