Avoid fixing on diagnosis
Dear Professionals!
Is the diagnosis the most important thing? How much attention do we need to pay to it?
As much as necessary, but not too much. What do I mean?
Well, the diagnosis in a process of psychotherapy of children, adolescents and families is important, but not the most important.
I would divide the diagnosis into two parts: a medical diagnosis according to DSM and ICD, but also a psychotherapeutic diagnosis. The diagnosis according to DSM and ICD is quite simple, especially when we work with a clinical psychologist, psychologist-diagnostician or a psychiatrist. Then we think about the diagnosis together. Of course, such cooperation depends on the customs in your country or work environment. Above all, I encourage you to cooperate with other professionals in order to make a medical diagnosis.
However, we are most interested in psychotherapeutic diagnosis. I call it a nuclear conflict after my wonderful personal psychotherapist Hanna Jaworska. The nuclear conflict is the patient's primary difficulty that prevents them from achieving psychological well-being. I discuss this type of diagnosis in more detail in "SAFE RELATIONSHIP ™ Basics" course. We will deal with this conflict throughout psychotherapeutic process, and certainly through a large part of it. Defining a nuclear conflict requires vigilance, analysis and focus on what the patient and their parents are telling and showing us. Thus, a psychotherapeutic diagnosis will be very useful for us and for the patient.
However, excessive concentration on medical diagnosis often does not serve well in therapeutic process.
Unfortunately, this may limit us and our patient, because we can constantly look for confirmation of the diagnosis in patient's behavior, until we forget what the patient reports, what is the purpose of therapy. It is very important to separate a person from a diagnosis, e.g. a patient with ADHD has symptoms of the disorder, but also other behaviors and problems not related to ADHD. Therefore, we deal with what is important for the process, not just the diagnosis. We do not ignore it, but we also do not fixate on it.
Currently, health and insurance systems would like psychotherapy to be based only on diagnosis and protocol, preferably short-term therapy. But this has nothing to do with reality, with individualization of working with our clients and with my favorite psychotherapeutic saying: "The slower, the faster" - I understand it that the less pressure we and our patient have to create a safe relationship, the better and faster we achieve results. If the psychotherapist's help would be limited to diagnosis and speed, we would lose contact with the real relationship, which takes time and is the basis of psychotherapy process.
