Diagnosisitis. Or, as it’s more commonly known, overpathologizing — an affliction that affects many counselors both seasoned and new.
People most often come to counselors because they have a problem and need help. As counselors, whenever someone comes to see us, we flip the switch and turn on the counselor brain. The counselor brain is a fascinating professional attachment that is installed in graduate school. It is great for a lot of things – problem-solving, empathizing, reflecting, critical thinking, etc.
There is one area, however, where the counselor brain works in overdrive, and this is not always a good thing. That area is pathologizing. Or in layman’s terms, diagnosing.
Counselors diagnose stuff; it’s what we do. And when you’re good at diagnosing things, it’s also kind of fun. When someone comes into the office and says, “I’ve been feeling sad …” the little mouse on the wheel inside my counselor brain starts sprinting, and I want to know about onset, frequency, intensity, duration and so forth. When someone says, “I have recurrent nightmares and panic attacks several times a week,” I immediately begin to think about the diagnostic criteria for posttraumatic stress disorder or acute stress disorder, formulating questions to get at specific symptoms and triggering events.
This comes naturally because it’s what I was taught and, frankly, it’s good practice. Because I work in managed care, I have to diagnose. That’s the only way the insurance company will pay my agency, which then pays me. There’s no way around it.
I am not anti-diagnosing; I am actually pro-diagnosing. Diagnosing is a good thing. If we can look at a symptom set and give it a label, we can treat it. The whole point of diagnosing is to provide clinical direction and give all members of the treatment team a clear picture of what the client’s underlying issue is and the goals for treatment. Sounds great! Ah, but there is one tiny problem: the fundamental attribution error.
The fundamental attribution error is not just a college-sounding phrase that impresses those around you. No, it’s much more than that. Diagnoses are made up of a symptom set, and the symptom set is attributed to the diagnosis (circular reasoning). Here is an example: Mr. X is sad. Why is Mr. X sad? Because Mr. X has depression. How do you know Mr. X has depression? Because Mr. X is sad. Huh? Mr. X has depression because he is sad and he is sad because he has depression.
This circular reasoning can insulate counselors from getting to true causes of disorders and helpful treatment solutions. This is why counselors are vulnerable to the fundamental attribution error, which is also known as attributing every symptom to a mental health disorder.
The first rule of diagnosing is to look at our symptom set and rule out medical conditions or substance abuse issues that could be causing the symptoms. If the client has a medical condition or is under the influence of a substance, he or she may present as having a mental disorder that is not truly there.
There is another critical area, however, that counselors (myself included) often miss: WELLNESS (it’s in all caps, so you know it’s important). What is wellness? Get out of the clinical mindset for a moment (Mr. X will identify three irrational thoughts that bring about distress and replace those thoughts with healthy and balanced ones … blah blah blah). I don’t mean to sound crass because the clinical stuff is great and it truly helps a lot of people, but we don’t need to start there. Start here, with 9-5-2-1-0, and find out if your clients are practicing proper wellness habits (this is great stuff for adults but solid gold for child clients).
9) Sleep: How many hours of sleep are you getting? Shoot for 8-9 hours. Have you been running on a lack of sleep? This one alone can look like a lot of mental health disorders (antisocial personality disorder is what it looks like for me before I have my coffee).
5) Eating: How is your diet? Aim for 5 servings of fruits and vegetables per day. Clean up your diet! For the brain to function properly, it has to be properly nourished.
2) Screen time: Aim for 2 hours or less per day. This goes for computers, television, cell phones, tablets, etc. I know this isn’t possible for a lot of people, mostly because their jobs may require them to look at a screen for 8 hours a day. The point with this one is to be mindful and cut down screen time whenever you can.
1) Exercise: Have you exercised lately? Go for at least 1 hour of exercise per day. This one is so important. Exercise acts as a natural antidepressant, releasing the “good feeling” chemicals into the brain.
0) No sugary drinks! These drinks are a diet and health killer. So drink 0 of them per day. This includes artificial sweeteners as well.
Here are some bonus wellness tips for you and your clients:
Connectivity: How connected are you to your community? Whether it’s attending church, participating is sports, volunteering or attending social functions, connectivity is a key to wellness.
Novelty: This one gets overlooked so many times. Learning a new skill (a musical instrument, a new sport, a hobby) takes a lot of brainpower — and that’s a good thing! Using your brain in this way creates new neural connections and (at the risk of getting too neuro-psychy) promoting integration among hemispheres in the brain is a key to wellness.
Humor: Don’t forget to laugh. After all, it is the best medicine.
These wellness principles should be the first goal of just about any treatment regimen, regardless of the client population with which the counselor is working (I believe it is most often overlooked when working with clients who have a low socioeconomic status). I work with children who have been abused and neglected, and it’s interesting to note that when their wellness is made a priority, many other symptoms seem to wash away. The clinical stuff is great, and it’s really, truly needed. Just don’t lose sight of the forest for the trees — or the person for the symptom cluster.
Thomas Winterman is a father, husband, therapist, author and blogger who lives in Panama City, Florida. He has worked in the mental health field for a number of years, mostly serving underprivileged children at a nonprofit agency as both a social worker and clinical counselor. You can find his blog at www.thethrivelife.org or email him at firstname.lastname@example.org. His first book, The Thrive Life, was published in April.
Also by Thomas Winterman, CT Online, April 2014: “On being a successful therapist”