To Diagnose Or To Not Diagnose. This is the Grunt.

I'm in the middle of a professional development course "Assessment and management of anxiety in children and young people". It's a School-Link training course, a joint initiative between the Departments of Education and Health (New south Wales).

It's being run by two exceptionally good practicioners, based in Sydney. (Rob McAlpine and Anthony Hillin- website link later when I can find it through the pages of course readings).

The advisory group for the curriculum development has been made up of people from the NSW Institute of Psychiatry, Dept Ed, TAFE, Community Mental Health and anyway, lots of professional people representing an array of care providing industires.

Sorry about all that - just felt I needed to provide some guts to where the next couple of posts will be coming from!

A highly informative and instructive course.

There are something to the tune of 16 anxiety disorders, as specified by the DSM IV (Diagnostic and Statisical Manual 4th ed.) Social phobia, panic disorder, specific phobia, post traumatic stress disorder, obsessives compulsive disorder, to name a few. Each have fairly specific treatment implications.

It became apparent that some people in the (very diverse) group felt it is not the prerogative of some professionals to offer diagnoses...That this role was to be left to "those of us who are able to make such diagnoses".

The concern is justified (We don't want incompetent people running around giving out labels to children and parents. Labels which have serious, long term implications). The arrogance with which it was delivered I think,is not.

I always roll my eyes when in a room of psychologists and professional intelligent people, we have this sort of carry-on.

There were two implications here:

1) that only clinical psychologists and the like were suitably qualified to diagnose and

2) that those "other" people working in this field are not able to exercize sound professional judgement in the process of diagnosis (That is, formulation and delivery...including the decision to deliver it or not).

What do you think?

My personal opinion (and way of working) is this: I don't give out labels/diagnoses without extreme caution and consultation with at least one other professional whose expertise is established. For the most part, I don't give out a diagnosis. I offer explanations and treatment strategies and as much help as I can. A diagnosis from me is mostly seen as a way of communication to another psychologist or professional who is working with the same client.

Within the school system, a diagnosis, not from me, but a paediatrician or psychiatrist is essential before needed funds can get to the school so the child can have support (and hopefully understanding too).

Other times, parents are asking you directly for a label. Giving them one lets them know that their child's condition is recognized, acknowledged and has a name. It reduces feelings of isolation and empowers them to be able to manage the thing. It's a positive experience. The sense of relief is palpable.

I'd love some feedback on this. It's a juicy one! What are your experiences with labelling and diagnosis?

Comments

[Lael]

oooh good topic!
I like that you tell people when they ask you directly. As a person on the other side,I know what you say to be true. It's very important.
I also agree with you and the method you use when you offer help and suffort without the label. I think it all depends on the situation and part of being a professional is knowing when to do what. Every situation is different.

Labelling is tricky. I always tell Ciari to be careful who tells(about her ADHD) because some people will react kindly and some won't,regardless of who she is or how she acts but based on the label itself. it works the other way too though. I have people who don't believe me because while she's hyper and all over the place,she's well behaved,lol. They think I'm lying or something based on their
pre-conceived notion of the label. It's weird!

[phd in yogurtry]

There are two broad reasons to diagnose, in my professional life: (1) guiding treatment (2) insurance requires one to pay. The first is beneficial and in some cases paramount. The second ranges from tolerable to problemmatic. While labels can be helpful, they can cause as many problems as they alleviate.

I am a clinical psychologist and I find that there is so much variability in the appropriateness and accuracy of diagnoses pronounced by a range of mental health professionals. Sometimes, I have found, psychiatrists' diagnoses being equally as questionable as "lesser qualified" professionals (i.e., are they giving the diagnosis to justify the meds they want to try?). So in many cases, it isn't the letters behind the name that dictates diagnostic appropriateness so much as the individual and the agenda. That said, there is a broader range of quality of master level training programs (phd programs too, but even moreso, I think, in the masters). I can recall many examples of talking to masters candidates about their thesis and was, frankly, flabbergasted at the high-schoolish quality of what was regarded as acceptable. And the limited breadth of course training in some cases was equally unsettling. So with that in mind, I do understand the need for diagnostic governance. This is unfair to those with masters degrees who deserve equal footing with phd's. There's really no easy solution.

[Alison Tuck]

Laelee, Thanks for that. I was hoping you'd drop by for a yap on this. I do so love your parenting style! A great piece of advice to your daughter on 'selective disclosure' (Please note too, that this is a lesson on picking up on cues about who is trustworthy and who's not - great skill to have).

I understand your frustration as well in sharing this sacred info on your kid and getting wacko responses. Cheers, Ms L.

phd, A measured and thoughtful response. Why weren't you there the other day? My sentiments exactly. Thank you.