Robyn Pope on the heroicagencies listserv reminded me of these great questions practitioners should ask before applying a diagnostic label to a client:
If we use labels, how do we ensure that we…
- demonstrate respect?
- bring hope?
- validate the culture of others?
- recognise the unique reality of others?
- assume people have good intentions?
- expose the expertise of others?
- avoid framing people as the problem?
- create pathways to change rather than make the problem worse?
- focus on solutions rather than problems?
- enable greater understanding?
- accept that we may be wrong?
Credit where due, these come from St Luke’s Resources.
Labels, including diagnostic ones, are only useful to the extent they enable constructive action. Personally, I tend to avoid them. This is partly because of the validity problems with diagnostic systems like the DSM. But mostly because my labelling someone turns therapy into NWS or “Now What?” Syndrome.
“Now What?” Syndrome is when you have a fantastic insight into and understanding of your problem or situation, yet still nothing changes. Therapists experience this sense of deflation when they offer a client a brilliant interpretation or explanation of the dynamics or development of the client’s problem, the therapist waits expectantly for the client to have a “Eureka!” moment, but instead the client comes back with “Well, yeah, but now what [do I do]?”
It’s not always like this though. I remain flexible around labelling because I have also had the experience of clients welcoming a diagnostic label, even finding it a source of relief or reassurance. This seems to happen more often, when the person’s condition has a hormonal or other biochemical dimension. For example, bipolar depression or Chronic Fatigue Syndrome (CFS). In these situations, when a diagnosis is first arrived at the person is likely to exclaim, “At last, this means I’m not crazy!” or “At least now I know there will be things I can do to deal with it and it’s not ‘just psychological’!”
What about you? If you’ve been in therapy, did you find being labelled helpful or not? If it was helpful how did it help? If it didn’t help, what made it difficult for you?
If you’re a practitioner, do you always diagnose? Why or why not? How have clients responded?
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And while you’re at it check out UK psychiatrist Sami Timimi’s campaign for ‘No More Psychiatric Labels’ at http://www.criticalpsychiatry.net/?p=527
And you can support the campaign at http://www.causes.com/causes/615071-no-more-psychiatric-labels/about
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