The Problem with Diagnoses
Recently, I sat with a young client who was convinced her mother is bi-polar. I asked why she thought that and she replied, “Because one moment she’s happy with me and the next she is yelling at me!”
This exchange is an example of what I am noticing more often in sessions: people diagnosing themselves and diagnosing other family members. One reason for this, I believe, is the over-saturation of psychobabble in media and on the web. I also believe it is in part due to our inherent need to place a label on the difficulty we’re facing. The thought may be, “If I can label it, I may move one step closer to controlling the outcome.”
To be sure, diagnoses are necessary in our field. They help us better communicate and consult about an issue or disorder. They help us to formulate hypotheses and to conceptualize our clients’ dis-eases. But they can also get in the way. Diagnoses may, in fact, keep us in problem-focused language and impede us from engaging in solution-focused language.
I find this to be especially true when the clients I serve begin to adopt diagnostic labels and integrate them into the fabric of their existence. When this happens, I often notice a sense of hopelessness, a sense that the person may think of themselves as ineffectual in the outcome.
One strategy I use when I find this dynamic is to help unpack for the client what the diagnoses means to them and what role it will play in their day-to-day activities and relations with others. I want to also help them externalize the diagnosis. For example, instead of someone saying, “I am OCD!” or “I am a control freak,” I want them to move toward the thought that “I am a person who is sometimes visited by a need to control outcomes.” My hope is that the client can see themselves as powerful human beings capable of prospering despite their disorder. I also hope that they can begin to see for themselves that they are not ALWAYS influenced by their issue; that there are times when they are successful in standing up to the problem.
This is also helpful when working with a family concerned about a family member’s issues. I want to gently begin challenging their use of language if they seem to refer to the individual as defined by the diagnosis. I want to help them reframe their thoughts and attitudes and help them explore how they will relate with the individual and the diagnosis separately. After all, if the diagnosis is valid, it is not going anywhere, at least for a while.
The challenge for family members is to explore how they relate to the individual suffering and how they have been impacted by the illness, not the individual. This exploration may then lead to solution-focused language, providing a sense of hope and empowerment, which may then lead to family healing.