It’s common for clients to enter therapy seeking answers and clarity around their mental health. Many expect their therapist to provide them with a diagnosis, believing this will lead to better treatment and understanding. However, there are several reasons why a responsible therapist may avoid diagnosis:
The DSM has limitations
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification used to diagnose mental disorders. However, some argue the DSM has serious limitations:
- Diagnoses are based on clusters of symptoms, which don’t necessarily capture an individual’s unique experiences.
- There are no objective tests to confirm most diagnoses – it’s left to the subjective judgement of the therapist.
- The lines between diagnoses are blurry, with a lot of overlap between categories.
- The DSM is heavily influenced by cultural biases, insurance companies, and pharmaceutical lobbyists.
Given this, some therapists prefer to avoid labels they feel are inadequate or misrepresent a client’s struggles.
Diagnosis can be counterproductive
For some clients, receiving a diagnosis can be unhelpful or even harmful to their care:
- They may fixate on the diagnosis and forget they are a complex person.
- They may feelhopelessabout improving if they believe they have an incurable “illness.”
- They may become passive recipients of treatment rather than active participants in their growth.
- They may be treated differently by family, friends, employers once labeled with a diagnosis.
In these cases, a therapist may avoid diagnosis to empower the client to define their own experiences.
Focus is on the client’s goals
Therapists increasingly recognize that clients are the experts on their own lives. As a result, therapy focuses on collaboratively helping the client achieve their goals, rather than telling them what’s “wrong” with them. Diagnosis is unnecessary for this goal-oriented approach.
Diagnosis can limit options
Once diagnosed:
- A client may feel pressured to take medication or receive other mainstream treatments.
- The therapist may unconsciously bias their view of what will help the client.
- The client’s insurance may limit coverage for alternative approaches.
Avoiding diagnosis keeps more options on the table. The therapist and client remain open to evolve the treatment plan in any direction that helps the client thrive.
Stigma of mental health issues
Despite progress, stigma around mental illness still exists. By not diagnosing, a therapist protects the client from judgement and discrimination from others.
It’s a process that takes time
Responsible diagnosis requires synthesizing details gathered over time. Therapists avoid prematurely labeling clients when they are still getting to know them. A clear picture emerges over time.
Assessment is ongoing
The best therapists constantly assess and diagnose in their heads based on what they learn from each session. They just don’t communicate a diagnosis to the client unless absolutely necessary.
We are all “disordered”
In different ways, we all struggle to adapt to the demands of life. So who determines what is ordered vs. disordered? With empathy and compassion, a therapist can help clients reduce suffering without placing judgement.
Not all therapists are qualified to diagnose
Only mental health professionals like psychologists, psychiatrists and clinical social workers have the training to assess and diagnose mental illness. Therapists with other backgrounds avoid operating outside their scope of practice.
The relationship comes first
Nothing is more vital to success in therapy than the relationship between the therapist and client. A responsible therapist prioritizes nurturing trust and understanding over neat labels that may damage the therapeutic bond.
Conclusion
Therapists avoid diagnosis for many reasons that ultimately serve the client’s best interests. Quality therapy does not require a diagnosis. Progress depends on the therapist and client working together with deep mutual understanding. If you seek a diagnosis in therapy, have an open discussion with your therapist about their reasons for not providing one at this time. Work together to determine if receiving a diagnosis would support your growth or not. You may find that focusing on self-discovery ultimately brings more lasting benefits than any label could provide.