Several times now in my counseling classes the diagnosis debate has come up: should we counselors confer diagnoses on clients? The concept of diagnosing is for sure a delicate one, full of complex ethical tangents, power dynamics, emotions and potential lifelong impact, let alone permanent records. Of course, as counselors, we will assess our clients, form hypotheses and at least make working diagnoses, in order to conceptualize clients’ challenges and plan treatment within the framework of a universal language. Sometimes—depending on the healthcare provider or the necessity of obtaining insurance coverage— diagnoses are mandated, and this question becomes moot. But for the sake of debate, let’s leave these instances out and consider an uncomplicated, ideal scenario: what are the benefits of giving a client a diagnosis, face to face, versus the risks?
A diagnosis could come as a huge relief to a client. It might assuage feelings of “just being crazy” or somehow at fault for the struggles in one’s life, erasing damaging layers of guilt and self-blame. It might be a desirable revelation to some clients to simply have a concrete answer to questions like “why do I feel like this?” or “what’s wrong with me?” A diagnosis could provide hope for greater self-understanding, more resources to explore, and structured, tried-and-true ideas for improvement-- now that a standard, publicly-recognized problem has been identified and named. Getting a diagnosis might even give some clients a sense of community or shared support, knowing that there are others out there with the same issue and that, therefore, they are not alone or “abnormal”. Such clients may come to truly “own” their diagnosis, coming to terms with it, knowing its familiar manifestations in their life, and integrating it as part of their identity.
On the other hand, though, at what point does a diagnosis become a confinement, a restriction of the client’s potential, a ceiling that can’t be moved beyond due to self-perceived expectations of the label, or a distorted reevaluation of one’s own abilities? Will some clients cease to push themselves, or put less energy into doing the intense personal work of therapy, now that they’ve settled into a “known quantity” identity? Would they feel defective, damaged, or less-than, by having the label of a diagnosis placed on them? Would they place limits on the dreams or ideals they are working toward, because those things aren’t within the description of their condition? As counselors we exist to help individuals reach their potential, working toward meaningful life goals and surpassing obstacles along the way. We must be careful that conferring a diagnosis on someone does not become another obstacle in their path, or—like so many assigned labels in life-- a self-fulfilling and limiting prophecy.
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