Problems with Insurance

I don't think people are "sick" and "pathological."

Just so it is clear to all readers: If someone sees a counselor, therapist, or psychologist and they want to have insurance pay for it, the client/patient must receive a diagnosis. According to my dictionary, a diagnosis is: "The process of determining by examination the nature and circumstances of a diseased condition."

We have a chicken and egg problem here. I will concede that one could find organic brain-function differences between people with emotional difficulties and those who don't have such problems, but how do we know that the organic differences caused the person to behave that way and not the other way around? Maybe unusual behavior traced a new path in the brain or caused new chemicals to flow. There is no scientific evidence to explain how it started.

All that can be put aside. Even if there were an organic impairment and even if that impairment causes the emotional problems, does that mean the name of the problem has to be a psychological disease? Why not let it be a medical disease? Like calling depression, for example, "serotonin re-uptake inhibition deficit?" And what if the reason for the problem is you just got divorced? Or, not even. Let's say someone just isn't happy with her or his job. Does that person need to be labeled as mentally ill?

This way of thinking is called a "deficit" outlook, a "deficiency" perspective. Something is wrong with the way one is. This way of seeing people keeps them from getting better! Let's look at an example. Does a child in school respond better to, "Jimmy, you made a lot of mistakes on your homework. You are really in bad shape. You have some serious problems. Now I am going to give you instructions as to what you need to do to fix them." or to, "Jimmy, I admit it looks like you messed up on your homework. But notice how well you did this problem. And look at this one over here. You really got the concept necessary to solve this tough one. Not everyone can do this sort of problem. How did you manage to get these over here correct? How did you know what to do?" The good teacher builds on whatever resources Jimmy has in order to show him that he already possesses the skills necessary to do even the hard parts. Now which way is most likely to result in the best motivated child?

Bottom line: No one wants to be reduced to a "little box."

In spite of all this, there might be clients who have been so beaten down as to believe they really are sick and should receive diagnosess. The worst problem with the disease model is that diagnoses imply permanence. Just giving the diagnosis "Borderline," for example, is so disheartening, most therapists feel cowed by it. How is the client supposed to feel motivated to work on his or her problems when the therapist is discouraged? Better leave the diagnosis book in the trash and look at each individual's problem as a problem with life. And why not? Life isn't easy.

One last argument needs to be addressed. Those in favor of diagnosis will say that one needs a diagnosis in order to proceed with treatment. That may be true in medicine but in therapy, study after study has repeatedly shown that the best indicator of success is a warm, empathetic regard on the part of the therapist for the client. Furthermore, hardly anyone uses diagnoses to decide on the therapy process anyway!

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