Yes, therapy is designed for you to work out issues, and the linear path of diagnosis and then treatment might be some people's experiences, but it's actually common for your therapist not to bring up a diagnosis.
Matt Lundquist, LCSW, a psychotherapist based in New York City, says that while therapy has traditionally taken a medicinal approach — in which doctors diagnose a patient and then go about using medicine to treat that diagnosis — some therapists opt to work on a non-diagnostic approach, where they look at a patient's health beyond a specific set of symptoms tied to an illness.
"Some therapists take a position that in certain circumstances, [the medicinal approach is] actually not the best way to proceed — that thinking about things in the language of diagnosis when it comes to people’s emotional problems is much too limiting, " he says.
At his own practice, Lundquist says that while he isn't against diagnosing a patient, it actually only happens about 10% of the time.
In fact, he says that he tends to steer away from diagnosing because the Diagnostic and and Statistical Manual of Mental Disorders (DSM), the standards by which doctors diagnose mental health disorders, doesn't encapsulate everyone's emotional problems (even though it gets updated every year).
"The DSM and diagnosis tends to present itself with a really heavy authority," he says. "It puts itself out there that this is the truth. It's really important that people understand that it might be a truth, and it might even be a very useful truth that really resonates with them, but that doesn’t mean that’s the only way they can be seen and understood."
That being said, sometimes hearing a doctor give you a diagnosis can be a huge relief, and a step towards helping you understand yourself better. But, Lundquist says that there are specific situations where a diagnosis is helpful and some situations where it isn't.
"It's really important that people understand that [diagnosis] isn't the only way they can be seen and understood."
Matt Lundquist, LCSW
"When I do [give a diagnosis], it’s because I think [the patient] would benefit from feeling like the set of experiences they have is experienced by other people," Lundquist says. For example, he says that someone who may have bipolar disorder and experience manic episodes could benefit from knowing their diagnosis.
"There are instances where there is a level of seriousness in what’s going on with somebody that they’re not fully grasping, and so it’s helpful to lean on the authority of diagnosis and the institution behind it to convey to somebody," he says.
Other times, a therapist may have a diagnosis in mind that they choose not to share, but it's not about withholding anything from a patient.
"There are some times when I think it might be useful to me, but it might not be useful to the patient," he says. "I think a lot of things in the context of work with patients. I share only a percentage of them and that’s not to be withholding, but I make decisions about what I think is going to be most useful."
Outside of the non-diagnostic approach, Lundquist says there may be times when a diagnosis, such as borderline personality disorder, is so stigmatized online and even among some psychiatrists and psychotherapists that telling a patient is rarely useful, because doing so could cause them to look up the disorder and find pessimistic and discouraging information.
Lundquist says that the lack of a diagnosis doesn't usually get in the way of treatment, but if you're more comfortable getting a more straightforward answer from your therapist, that's something you should bring up during your sessions.
"The relationship [between a patient and therapist] is important, and healing takes place in that context," he says.
At the end of the day, your relationship with your therapist is just that: a relationship that requires communication. If there's something you're not happy with, you should absolutely voice it, or even find a new therapist if you don't think your current one is the right fit. Just know that if your therapist hasn't given you your diagnosis, it doesn't mean they're trying to be cagey.
"People are incredibly complicated, and we can’t be boiled down to half a dozen symptoms," Lundquist says. "And our treatment can't be boiled down to a particular protocol, that might have come out of a university six years ago, about how to treat [those symptoms]."
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