All therapy involves some diagnosing to determine what type of treatment modality will be most effective. I believe the art of evaluation, which results in diagnosis, should be taken seriously. Unfortunately, many people are labeled and never get the appropriate care. One of the overarching purposes of the DSM-V Diagnosis Manual and ICD-10-CM Codes is to provide descriptions, symptoms, and other criteria to establish whether a patient has a specific mental health disorder. The ability to define a constellation of symptoms that other patients share, give it a name, and understand the potential treatment options for the disorder is necessary for the provider and useful for the patient.

 

While taking a course in psychopathology at the UNC-Chapel Hill, I was struck by a professor’s insistence that we never refer to anyone as "Bi-Polar," or "Alcoholic" or "Schizophrenic."  She was adamant that those words are merely labels, and do not describe the people as individuals.  When we refer to others as a diagnosis, they lose their dignity.  Therefore, I diagnose in order to help a person with a treatment plan that will work, but not to label or stigmatize.

 

In my practice, I work primarily with adults age 18 to 85+ who are struggling with issues related to anxiety, depression, Bi-Polar Disorder, loss and grief/bereavement, transitional/adjustment issues, and relationship issues.  These are the issues we deal with as part of being human.  I think it is interesting to note that mental health issues all start with the good intention of self-protection--it is the brain’s attempt to take care of us. A little anxiety helps get things done, a little depression provides empathy and compassion, a bit of hypo-mania can lead to creativity.  However, when any of these human experiences become so pronounced that it negatively impacts functioning and quality of life, then it becomes a mental health issue that needs to be addressed.

 

A brief disclaimer is needed regarding my status as a Licensed Addiction Counselor (LAC). Over the years, I have noticed that clients who struggle with alcohol or drug use have frequently used these substances in an unsuccessful attempt to regulate or medicate their mood issues. Often, clients have underlying anxiety or depressive issue that needs to be explored while concurrently addressing their substance use.  So while I have retained by LAC license, I do not treat substance abuse as a primary problem but only as a co-current issue.

 

I like to think of therapy as both a sacred event and a bullshit-free zone where any and all topics can be freely discussed. One of the most important factors for successful therapy is the therapeutic relationship. Research focusing on the value of different treatment modalities most often show that patients do not remember the type of treatment provided but do remember the relationship they felt with their therapist, and the most successful outcomes are correlated with the most positive feelings of connection. 

I embrace humor as a component of therapy. The ability to laugh helps us see issues from another perspective and can be a way to talk about difficult issues. As long as humor is not used as a way to engage in self-deprecation, minimize pain, or make fun of others, humor can actually be healing. 

 

There is another disclaimer about therapy, which is that often we feel worse before feeling better. In order to feel happier, relaxed and in control, we have to work through the muck of our lives that makes us feel bad, powerless or anxious. We have to identify and deal with those hidden, shameful or painful parts of ourselves that are controlling our emotions.  Until we "make the unconscious conscious," as Jung would say, those unknown parts of ourselves have too much control over our lives and may be ruining our lives.  Such self-discovery can be frightening and initially cause new pain; this is an intrinsic risk of therapy, but in my estimation, a risk worth taking.