Have you ever wondered why mental health professionals diagnose conditions and how it shapes the therapy journey? This episode unpacks the crucial role of diagnoses in understanding clients’ challenges, crafting effective treatment plans, and fostering collaboration with other healthcare providers. We discuss how diagnoses guide evidence-based practices, validate client experiences, and ensure access to resources like insurance coverage. You’ll also hear about the thoughtful steps therapists take to ensure a diagnosis reflects individual experiences without defining them. Join us for an insightful conversation on how diagnoses are tools for healing, not labels.
Tune in to see Why We Diagnose Through a Therapist’s Eyes.
Think about these three questions as you listen:
- Why do therapists need to diagnose mental health conditions, and how does it benefit the therapy process?
- How does a diagnosis influence the treatment plan or therapy techniques you choose?
- What steps do you take to ensure a diagnosis accurately reflects a client’s experiences and doesn’t negatively label them?
Links referenced during the show:
https://www.throughatherapistseyes.com/category/podcasts/addiction
https://www.throughatherapistseyes.com/category/podcasts/selfmanagement
Intro Music by Reid Ferguson – https://reidtferguson.com/
@reidtferguson – https://www.instagram.com/reidtferguson/
https://www.facebook.com/reidtferguson
https://open.spotify.com/artist/3isWD3wykFcLXPUmBzpJxg
Audio Podcast Version Only
Podcast: Play in new window | Download
Episode #297 Transcription
Victoria Pendergrass: [00:00:00] Hi, welcome to Through a Therapist’s Eyes, where you get insights from your home and your car. And today we are talking about why do we diagnose for episode 297.
John-Nelson Pope: 297, that is excellent. And
Victoria Pendergrass: I am Victoria Pendergrass, here to replace Chris for the day.
John-Nelson Pope: No one can replace Chris. Oh yeah,
Victoria Pendergrass: sorry, wrong choice of words.
And we have here
John-Nelson Pope: John Nelson Pope.
Victoria Pendergrass: The Pope.
John-Nelson Pope: The pope joining
Victoria Pendergrass: us today as usual. You weren’t here last week though, were you? No,
John-Nelson Pope: because my wife was in the hospital.
Victoria Pendergrass: And she’s doing okay.
John-Nelson Pope: She’s doing okay.
Victoria Pendergrass: Well, we’re glad you’re back.
John-Nelson Pope: I’m
Victoria Pendergrass: glad you’re kicking it with me today.
John-Nelson Pope: Well, we’re gonna kick it together.
Victoria Pendergrass: Yeah.
John-Nelson Pope: Or we’re gonna kick the bucket.
Victoria Pendergrass: Today is November 21st, right? I got that right? Yep. Of 2024. Thanksgiving around the corner. 2025’s around the [00:01:00] corner. It’ll be here before we know it. Let’s see we got ratings. What should they rate us on?
John-Nelson Pope: They should always rate us at a five. That’s the highest you can go,
Victoria Pendergrass: right?
Five stars,
John-Nelson Pope: five stars, and that, that will send us up through the different types of platforms like
Victoria Pendergrass: also help the algorithm. It’ll help us reach more people. And also we don’t. Really want anything less than five stars.
John-Nelson Pope: No, that’s right.
Victoria Pendergrass: Yeah Let’s see. What else we got for today. Okay, this is not to deliver any therapy services of any kind
John-Nelson Pope: That’s right, but we’re, this is to provoke discussion and, and thought.
Victoria Pendergrass: Yeah. Today’s questions are, let’s see, so the title is why do we diagnose and our questions today are, why do therapists need to diagnose mental health conditions and how does it benefit the therapy process? How does a diagnosis [00:02:00] influence the treatment plan or therapy techniques that the therapist chooses to use?
And then lastly, what steps do you take to ensure a diagnosis accurately reflects the client’s experiences and doesn’t negatively label them? Okay. So the, as Chris always says, this is the human emotional experience in which we endeavor to figure out together.
John-Nelson Pope: Oh, that is perfect.
Victoria Pendergrass: Did I get it?
John-Nelson Pope: I think so.
Victoria Pendergrass: And he usually throws that paper right there and lets it fly. Okay. So what is your experience with like diagnosis? I know we’ve talked about diagnosis before on the podcast, but like just, we talked, I think Neil’s like, we talked specifically. Just about, like, what diagnosis is, but we’ve never really talked about, like, why or maybe, like, how us as therapists use, like, diagnosis [00:03:00] in, like, our day to day sessions with our clients.
And in the long term,
John-Nelson Pope: I think diagnosis has actually been used since the earliest days of, of psychotherapy and the early psychoanalytical psychoanalyst,
Used it and the source they were, they were trying to come up with sort of a template. In order to be able to say, well, why do certain people behave the way they do and, and act?
And what’s happened is over the years it’s changed. A lot of times the diagnosis, for example, being having Homosexuality. And it used to be considered a mental illness. Mm-Hmm. it’s, and it was removed, right? Yeah. From the DSM five. The DSM five first had its roots like in the 1950s.
Victoria Pendergrass: Okay.
And,
John-Nelson Pope: And so it, and it was much smaller volume. I
Victoria Pendergrass: was gonna say, is that when the first DSM Right came out, and,
John-Nelson Pope: and that’s a go ahead.
Victoria Pendergrass: For those who don’t know that it stands for, look, I’m gonna mess it up. It’s [00:04:00] the Diagnostic and Statistical Manual of Mental Disorders. It’s our, like, book. Our quote unquote Bible.
And it gets bigger and bigger every year. For how we diagnose people. And I would be, you’d be hard pressed probably to find a therapist that actually knows every single diagnosis. No, I don’t think you would find anybody. Yeah. So is that when the first one came out? Right. Early, early 50s.
John-Nelson Pope: 51, 52.
Something like that. And so they’ve had,
Victoria Pendergrass: it was like, now it was,
John-Nelson Pope: it was really small.
Victoria Pendergrass: I don’t think I can reach Chris’s that he has here in the office, but yeah, it’s now like what DSM five is probably about like this thick.
John-Nelson Pope: Right now, now we have the DSM five TR and I noticed Chris doesn’t have that but it’s new.
It’s okay. So there’s an
Victoria Pendergrass: even. When, when that came out,
John-Nelson Pope: it’s a revised is about two years ago when the revised version came out and not a lot of things change. So it’s one of these things where you could just keep adding on and on and on. And [00:05:00] eventually we’ll have the DSM five or DSM six, but, but. But the, the thing is, is that it’s, it, it’s from a lot of different therapists and psychiatrists, psychologists, social workers, mental health counselors, marriage and family folks that contribute to it for behavioral health.
Victoria Pendergrass: Yeah. Cause you’re actually the one that brought the topic up to me and then I figured out like the, yeah,
John-Nelson Pope: you did this. I went with it. She did a great job.
Victoria Pendergrass: But yeah, but you’re the one that was like, well, we’ve never really talked about like why we use the diagnosis. So, let’s start with what exactly is a mental health diagnosis.
So this is the definition that I pulled from chat GPT, which is now my new favorite thing that I use all the time. But okay. So it says that a mental health diagnosis is a formal identification of a psychological condition or disorder. based on a person’s symptoms, [00:06:00] behaviors, and experiences. It is determined by a trained mental health professional, such as a therapist, psychologist, or psychiatrist, using standardized criteria from diagnostic manuals like the DSM 5, which we just talked about, or the ICD 11, which is the International Classification of Diseases, which that’s more of like a
John-Nelson Pope: That’s for all the diseases.
So it’s not just me. Yeah. That’s
Victoria Pendergrass: also, I think, if I’m, that’s more of like a world.
John-Nelson Pope: Yes, it is. Like a world health organization. Yeah.
Victoria Pendergrass: Than the DSM 5. Huh.
John-Nelson Pope: Right.
Victoria Pendergrass: But yeah, most, I think, most therapists, like you and I, we use the DSM 5. Yeah.
John-Nelson Pope: Anglophone countries use the DSM 5. Right for the most most part.
Victoria Pendergrass: Yeah, if you had to guess what would you say are like the most common? Types of like mental health diagnoses.
John-Nelson Pope: Well, I think anxiety.
Victoria Pendergrass: Yeah. Is that, that’s the first one that comes to [00:07:00] your
John-Nelson Pope: mind, I think that would probably be, I think, I think most, there are more people that are anxious as opposed to being depressed.
And then there’s a, the folks that are both anxious and depressed and right. And these can come from external sources. And I mean, you, you
Victoria Pendergrass: can have like situational depression, situational
John-Nelson Pope: depression. And sometimes people people resist the fact that, that there’s also an organic, maybe even a genetic component, familial component to both anxiety and depression.
But, but most, most of it is just. Living in a world that doesn’t seem to make sense. And so you, you have to, an absurd an absurd world that we live in and so that’s how we, we kind of react and we, we learn how to adapt and we maladapt a lot of times.
Victoria Pendergrass: So why do you [00:08:00] think that, or what would you say, like why do you think therapists even a mental health diagnosis to begin with to give to clients.
Like, what does, what does that mean?
John-Nelson Pope: I think, yeah. What do you think? This is what I think, I think, I think you have to get a baseline. Okay. As to, so you use the DSM five or the ICD 11, and what you do is you say, do these, fit these symptoms? And these are been compendium of symptoms for the last 70 years.
And so you get criteria, excuse me, and you get all these criteria. And basically this is what depression is. This is what anxiety is. This is what having a mood disorder is. And you do this to get an initial basis, a diagnosis of what a person is going through, what their experience is that you take and listen very carefully.
And you [00:09:00] ask probing questions and you let the, the, The client or the patient talk, and then you you kind of run down a list. It’s not something you just tick off, but it’s, there’s also, but it, you kind of interact with, with the criteria to help find what is the, where this person’s coming from. The other thing is it’s hard to sometimes diagnose somebody from the.
From the very beginning. And so in my say the same
Victoria Pendergrass: thing.
John-Nelson Pope: Yeah. And the way our insurance companies work. Mm-Hmm. is you have to put somebody
Victoria Pendergrass: Yeah. And we’ll get, yeah, we’ll get to that. But yeah, I was literally just about to say that sometimes we can’t even give a proper diagnosis for someone on that first session.
John-Nelson Pope: For example, mood disorder, you can have, be very very depressed. And that comes off as a, as a depression is
Victoria Pendergrass: a mood disorder,
John-Nelson Pope: a major depressive disorder, and that’s not what it [00:10:00] is. It’s more like bipolar or something of this or
Victoria Pendergrass: something might present itself one way. Sometimes things like. Trauma and ADHD can be very similar.
Trauma. Very much. And so, you know. And
John-Nelson Pope: again, ADHD is, is an, actually is an organic,
Victoria Pendergrass: neurological thing. Or neurodevelopmental. Right.
John-Nelson Pope: Dysphoria.
Victoria Pendergrass: But,
John-Nelson Pope: you could get to, you could become depressed situationally because you’re, you’re not relating well to the world or the world’s not relating to you. Yeah. And so that would make one isolated and might feel depressed.
Victoria Pendergrass: Do you think, it’s not necessarily a question that we posed at the beginning, but out of curiosity, do you, what do you, what do you think your typical client’s fear is about like diagnosis and how it might be used? [00:11:00] And like, not necessarily what we do, but what do you think are people’s fears, or like, the, what people are afraid of when it comes to diabetes use?
I think
John-Nelson Pope: people are fearing fearing stigmas being stigmatized for it. And they might have a problem. One of, I have a client whose wife is convinced that, You don’t need to have any therapy. You don’t need to take medication. There’s no such thing as mental illness. It’s just you need to pull up your bootstraps and suck it up.
Yeah. Interestingly enough, she’s had relatives that have shot themselves, or one of them, and committed suicide.
Victoria Pendergrass: Right.
John-Nelson Pope: And she still held on to that belief.
Victoria Pendergrass: And so,
John-Nelson Pope: but it was the husband, the husband, the husband felt her husband felt like, you know, I’ve got depression, I’ve got anxiety, I need to talk about [00:12:00] it.
Victoria Pendergrass: Right. Yeah. I definitely think that people are afraid of it. One, stigmatism, like what, or stereotyping, like, you know, what depression, you know, that whole, the thing that always comes to my mind is, I don’t know if you, it was for a medication, like a depression medication, but it was like this woman who basically was carrying around this, Like smiley face mask.
Yeah, and it was covering like her sadness, you know She would be in public and she would like pull this mask out of her Purse or whatever and make it look like right he was Smiling and all these things and I mean it was for a medication, but I think like those stereotypical things but I mean we’ve talked about this before that like Specifically depression can show up as anger for some people not sadness And so I think that when you people have these [00:13:00] stereotypical things it does Maybe create some apprehension into like well, okay.
Well, what does this mean? What will other people think about me? Yeah You know, if they know that I’m border, have borderline personality disorder, or if I have, like, bipolar, or And they’re gonna
John-Nelson Pope: And that’s the thing is, is that it, there’s a reverse aspect to it as well and that is that somebody could wear that as a badge of honor and sort of say, well, I’m not going to, you know, I’m not going to change, this is the way I am and there’s nothing I
Victoria Pendergrass: can do about it and nothing
John-Nelson Pope: I can do about it and I think that’s a, that’s a problem too.
Victoria Pendergrass: And I don’t know if this necessarily relates, I think it does, but it makes me think of, and I’m sure, and I’m, I can almost guarantee that this has probably happened to you because you have way more years experience than I do, but I can remember working in the school system during one during my school counseling internship for my school counseling masters, but then also [00:14:00] doing school based therapy after grad school.
And I specifically remember different moments throughout those years where parents would ask me, I would give a, you know, I would meet with their kid, do the initial assessment, you know, take all my observations, talk to teachers, do all the things. And the parents would make comments about like, well, is this going to show up on their records forever?
Is this, I don’t want this to show up on their record. Like I don’t want, you know, it to show up on their record that my kid has ADHD or that my kid has
depression or anxiety or whatever. And I think that. You know, not a fault of their own, but that comes from like the stigma and like how people view the negativity around certain disorders and or certain mental health
John-Nelson Pope: Well, let’s get into military for example They, [00:15:00] they are, they have issues with people that might be previously diagnosed and noticed with psychiatric issues or psychosis.
And so you have to be very careful. In the military, they, they, there’s, there’s several levels going on there is that one is that. They don’t want to accept somebody that may have, that’s going to be out of commission and not be able to deploy, which is
Victoria Pendergrass: very important. We might be getting too off topic here, but like, what is that?
Because like even things with medication, you know, like for example, and I’ve talked about this on the podcast before, so that’s why I’m open about it. But like, I’ve been on like forms of ADHD meds for like, Basically my whole life. And so like, I think you
John-Nelson Pope: can get a waiver for that.
Victoria Pendergrass: Well, I’m just saying, but those are factors into life that they consider.
And so, yeah, I can see how [00:16:00] sometimes with those stigmas, people are afraid.
John-Nelson Pope: But insurance companies, the same thing, even though they make you diagnose people on one level, which for, and I say the insurance company makes you do that. Is that if you want to get paid,
Reimbursed.
John-Nelson Pope: Reimbursed, you do it. But the other is, is at the same time they may be more reluctant to insure you.
Victoria Pendergrass: So that goes into one of the reasons. Why we diagnose right is access to insurance coverage. So to, I guess, explain a little bit more about that is, so when someone comes to us and they want mental health services we have like a flat rate for like our initial sessions and our like individual sessions after that first one.
For the if you want to use insurance Which would typically mean that you get as the client pay a discounted rate, right? You [00:17:00] pay a copay of some sort but then that also means that We get paid on the back end like through the insurance company pays like the full amount to us but then you only have to pay a percentage of that and in order to do that, like you said we typically if we file with insurance, we have to give a diagnosis that says like, Hey, one, we saw this person.
We actually did see this person and like, here’s why we need to continue to see them.
John-Nelson Pope: And that’s, that’s right. Am I missing anything? No. No. And I think, I think the thing is, is that we, I think we have to be conservative how we, As therapist to, to diagnose somebody as well for the insurance to the insurance company.
We want to have a precise and concise diagnosis, but at the same time, we don’t want to stigmatize the, the client. That he or she has, [00:18:00] has issues now, if it’s, it’s something that is in terms of like having a major mood disorder,
right?
John-Nelson Pope: Bipolar one, a bipolar two, you really, or a schizo schizophrenia or something like that, you’ve got to to do that.
But let’s say somebody is you don’t overdiagnose. In other words, if you have somebody that is having adjustment problems, you pretty, you don’t want to just say they have major mood disorder, right? Like that. You, you don’t want to, yeah,
Victoria Pendergrass: just because we want to be reimbursed, you know, we’re going to just throw a diagnosis, very ethical, yes, yes.
And you know, Hopefully, if you’re, you know, seeking therapy from a licensed person, they have this ethics driven mentality of, yes, let’s not, you know, let’s do this to, so that we’re there to benefit the client rather than to pay my mortgage, which, I mean, I am here to pay my [00:19:00] mortgage, but I’m also here to make sure that, like, I do it ethically.
You
John-Nelson Pope: have a Maserat
Victoria Pendergrass: Absolutely not. What is that? No, I’m just kidding. It’s a
John-Nelson Pope: car. Well, if you have to ask, you don’t know. Right, yeah.
Victoria Pendergrass: Okay. Neil’s got the mic. You guys have something to add?
Neil Robinson: Quick question. When someone comes to therapy and you talk about diagnosis. What’s the timeline to, to, to give a diagnosis?
So when it comes to insurance, so if I’m coming in here and like, I don’t know what my problem is, I have issues and it’s insurance starts covering it, right? Well, to keep going, I feel like you have to have some. So what is kind of like rough idea? Like how long can someone come without a diagnosis that the insurance won’t cover it?
You’ve got to do it.
Victoria Pendergrass: Yeah, none. Like we have, so say you come in for an initial assessment an initial assessment for whatever reason for us to file with insurance that session, we have to provide a diagnosis. From my, from what I’ve done, we [00:20:00] can always change that diagnosis. So say, say in my first meeting with you Neal, I’m like, okay, Neal has depression, right?
So I put down depression as our major depressive disorder as your diagnosis. But then we meet like two or three more times and I’m like, okay, wait, maybe it’s not depression. Maybe it’s bipolar or maybe it’s borderline personality disorder or something. I can change that. And then I justify it in the notes that I write afterwards.
Neil Robinson: So those intake forms become very important so that we at least can come in. You would have an idea what they’re saying. You can talk to them to kind of either further, either further enforce or basically change what you’re saying. We
Victoria Pendergrass: even do things called like rule outs in our And our assessments like I might again diagnose you with major depressive disorder, but then if there’s an inkling in there like, oh, this could be something else.
I might I’ll put like an R slash o for rule out of like, [00:21:00] bipolar or borderline or something else. So that can be like, okay, I think it’s major depressive, but it could also be or could not also be like one of these other things.
John-Nelson Pope: I’m someone who believes in assessments in terms of in terms of doing like Beck Beck depression, Beck anxiety, the generalized anxiety MDQs, and you use those as a, as a baseline.
of, of, of doing this. And so you can also later on as a person improves or let’s say it’s not working, you can give them more assessments later to see it. Should we change the diagnosis? Because you could have somebody for, for months and that’s, they said, well, I’m I’m depressed for example. That’s not their issue.
I know that’s hard to believe, but sometimes it is something else. And so you have to try a different type of, of, of, of [00:22:00] therapeutic intervention.
Yeah.
Neil Robinson: Right. So going back to that is basically from the time you go start therapy, it’s a therapist job to set a diagnosis. Doesn’t make it good or bad. It’s just, there has to be something there for medical purposes.
Plus I know in the notes, one of the reasons is also helps you set your treatment plan, right?
Correct. So when you
Neil Robinson: come in. Intake figure what’s going on that helps the therapist start the process. So don’t think diagnosis as a bad thing. As you said, the stigma is very important and it’s really beneficial for them.
Victoria Pendergrass: If you come in and you’re in your initial diagnosis from me or whoever is depression, your treatment plan, which is the course that therapists follow to help Help you is going to look different than if your diagnosis was ADHD
John-Nelson Pope: When you learned in your school About about treatment plans,
Victoria Pendergrass: oh gosh, that seems like forever ago, but yeah, I
John-Nelson Pope: know but do you [00:23:00] take a look every six weeks eight weeks
Victoria Pendergrass: At a treatment plan at
John-Nelson Pope: a treatment plant.
Well,
Victoria Pendergrass: see My experience has been It all over the place. So sometimes, you know, here we’re like this hybrid private practice thing, whatever Curtis calls it, is ours. We can do our own thing as far as treatment plans, right? Right. Now, when I worked And did my agency at or did my internship at an agency when I was in grad school And when I did school based therapy They had like specific templates for us to fill out for treatment plans right that had like goals had like strengths and Struggles and like all these things listed on it and that we did have to like date it You had to like go through and review it with your client and date it every You know six weeks or so six months to eight weeks or whatever, and like be more consistent.
And I think, you know, here, personally, I [00:24:00] don’t necessarily have like a printed paper. It’s more of just like an open conversation that I do with my clients as far as like goals. And I might put that in the initial assessment. Oh, you give it
John-Nelson Pope: the human touch, which I think, and I think that’s the downside with some of the agency stuff.
I mean, I literally
Victoria Pendergrass: only have one client who likes to do that. It’s paperwork homework, and she knows who she is, but everyone else does not want me to like paper. I had a person,
John-Nelson Pope: I had a person came, come back to me. She came back. Don’t give me homework. I won’t do it.
Victoria Pendergrass: Most people do. I literally have one client who’s like, I literally need to walk out of here with a paper of homework every time.
But I mean, like, I mean, Neil and you bring up a good point of like, Your diagnosis is going to affect the treatment plan that we create. So we do need to have an accurate representation and typically for me, again I don’t know about you, John, I, when it comes to a diagnosis, especially if we’re using like EAP, which is Employee Assistance Program which is, you know, Like your job will [00:25:00] offer to pay for therapy for you And for those like we definitely have to have a diagnosis because it’s going through an insurance I typically have that conversation with my clients.
I don’t know about you, but I have a conversation that’s like, okay You know, I have to give a diagnosis for insurance reasons and this is where my brain is at with that like Do you have any questions about that? Do you like? I don’t depend. We’ve talked. No, we
John-Nelson Pope: do. I do that.
Victoria Pendergrass: You do that. Yeah. We have a responsibility
John-Nelson Pope: to do that.
I think it’s a responsible to tell your clients what you think’s going on with them. That’s why they’re there. Right. And, and so,
Victoria Pendergrass: so we also have another why is I think. What do you think about like helping with effective or enhancing communication between you and your client? Right? So what do you think like that might look like for you?
Okay. In your practice? [00:26:00] Well,
John-Nelson Pope: when you say enhancing communication, you’re saying, you know why am I doing what I’m doing? I mean, the person, why am I feeling the way I’m feeling? And of course it’s, the client has to be able to express that and do that. But this may help, a diagnosis may help explain what’s going on inside of them.
And they, they can actually get some purchase or actually get a a grip as to what is causing their distress. And so that can be very helpful and that gives them hope.
Victoria Pendergrass: Right.
John-Nelson Pope: Because I think some folks are just absolutely chaos. They’re in chaos. And so they need to have something that will help them hold on and say, okay, we, we’re not perfect,
but
John-Nelson Pope: this is, this is what I’m, what we’re working on in terms of a diagnosis.
And this is how we’re going to approach it and get better.
Victoria Pendergrass: But what about also Not just [00:27:00] enhancing communication between you as a therapist and your client, but also like enhancing communication between you as a therapist. And the other health care providers that your client might be seeing. I think
John-Nelson Pope: that’s very important.
Yeah, so
Victoria Pendergrass: like, again, if I give, sorry Neil, you’re my little, you’re my example now. But if I give Neil a depression, a major depressive disorder diagnosis, then he can No, he’s
John-Nelson Pope: more bipolar, but Yeah, for sure,
Victoria Pendergrass: yeah. But, if, now he can take that to his, to his, PCP, his primary care provider, or he can take that to a psychiatrist or he can take that to who, what, what, what other ever else meant.
So healthcare providers. And so that that way everyone is on the same page. Have
John-Nelson Pope: they gotten back to you, the providers to, to. to say, help, help me get a feeling of what he needs, right? Yeah.
Victoria Pendergrass: And I’ve
John-Nelson Pope: had that both ways. Yeah.
Victoria Pendergrass: I’ve had, I’ve had providers reach out to me. I’ve also had clients [00:28:00] specifically asked that I reach out to, you know, that I keep in contact with their psychiatrist or their primary care provider, because that’s also going and then when you throw, when you throw in things like medication, that’s also going to significantly help your provider be able to prescribe you the proper like medication, you know, and that can get messy if we’re all on different pages as far as what Neal’s diagnosis is, sorry Neal.
John-Nelson Pope: Well, here’s a, here’s another thought in this. If a person is not compliant with his or her medication, that’s going to be key to one’s recovery, I think, in terms of, because you can that will help you with the symptoms, but to get to the root of the issues where that person doesn’t go back.
One of the
John-Nelson Pope: problems is that sometimes the clients go off, I’m feeling better.
And I, they [00:29:00] go off, but they go back to their old stinking thinking. And so I think it’s important to be able to, to, to go to another colleague who’s a medical colleague and say, okay, I don’t think I’ve been given permission to talk to you and we’re talking, we’ve got all those little waivers done.
I think that so and so is not using the medication or it’s not. as effective as it could be is there, there’s some side effects that they say that they’re having, that’s not helpful. Yeah. And so I think it’s important to,
Victoria Pendergrass: yeah, I always compare it. And I, it’s funny, I literally was just talking about this to a client earlier today.
I always compare it to when you’re given antibiotics, how they tell you to like take the whole bottle, even when you start feeling better.
Yeah.
Victoria Pendergrass: It’s like same thing. Yeah. You got to just, and, but I think when we. The why being to enhance communication between all these people, not just between you and your therapist, but between all the it’s a [00:30:00] lingua
John-Nelson Pope: franca.
It’s a common language.
Victoria Pendergrass: Okay. I was like, Oh, what?
John-Nelson Pope: A lingua franca.
Victoria Pendergrass: And then Lastly, at least for the why, before we move into the how we use it, the why, I think it helps like provide just like validation and understanding for the client themselves. And we’ve kind of hinted on that throughout and like,
John-Nelson Pope: I have a client, I had a client that said, Am I crazy?
Victoria Pendergrass: Right.
John-Nelson Pope: And I say, no, you’re not crazy. And then an hour later she’ll, or next session, she’ll say, oh, am I crazy? Yeah. My husband says I’m crazy.
Victoria Pendergrass: Yeah. And I’m saying,
John-Nelson Pope: well, tell me how. And of course, so,
Victoria Pendergrass: and, but then like giving a diagnosis to her mean,
John-Nelson Pope: yeah, well, I think it gives her some, again, I use the word purchase.
It gives her an idea of saying validation that no, she’s not crazy because craziness is absolutely rare.
Right. I mean,
John-Nelson Pope: there’s [00:31:00] insanity. The actual craziness.
Victoria Pendergrass: Yeah. Craziness or
John-Nelson Pope: insanity is rare.
Victoria Pendergrass: Well, and I think a lot of times because people have been experiencing whatever these symptoms are for however many years, it can be quite refreshing to actually be able to have A diagnosis to put with that like the example I always like to give and I think I gave this when we actually had our episode of talking about like specifically diagnosis in internship I had a client who she was just given a diagnosis previously of depression and that was on her chart And, but she mentioned that, like, no one else really talked to her about it.
No one else really explained, like, what that meant. And I went through with her, and I remember this so vividly. I, like, read, brought out my DSM 5, and I read through depression, and, like, read through the symptoms, and she was, like, by the end of it, she was so, like, because [00:32:00] for her, it was like, it was just this like, Oh my gosh, this is like, I’ve been experiencing literally all of these symptoms that you’ve been describing.
And now I have a name to put with it. And it was like, I mean, I will probably never forget that session. Like for the rest of my life, like it was just so profound. We
John-Nelson Pope: had a clinic when I taught at Monterey. Excuse me. Actually I taught it. I ran clinics at two places at Texas A& M and Corpus Christi at ULM university of Louisiana, Monroe, and also at Monterey.
And I would sometimes we’d get people that would be basically indigent, couldn’t afford for therapy,
right?
John-Nelson Pope: And so they would be going through the public system and a mental health system or health center system. And they’d come in and they would have, it was DSM five of [00:33:00] their, their notes. Okay. And people would just basically just diagnose.
And diagnose and they would they would, and this person ended up with like six or seven diagnoses because the therapist didn’t do her job or his job and say, okay, let’s start over. Let’s reassess.
Victoria Pendergrass: Right.
John-Nelson Pope: And so so they get piled up with all these things and so they start having an identity.
I
John-Nelson Pope: think that I’m broken.
I’m so broken,
right? So
John-Nelson Pope: part of this is we, we have to be very parsimonious and with our diagnosis and make it as, as clean as possible,
right?
John-Nelson Pope: And make it as a surgical scalpel to cut out. The bad stuff and to be able to, to help. So that, that’s my point. If you can,
Victoria Pendergrass: that’s probably one of our very like proud moments [00:34:00] as a therapist is like, I just instinctively like knew what to do.
And it was like, this like person was given this diagnosis and never really like.
John-Nelson Pope: And you did, you explained it and that took a lot of weight off that person.
Victoria Pendergrass: And lastly with this is, you know, diagnosis is not meant to label someone negatively. That’s not why we use diagnosis. It’s meant to, like we’ve said, guide an effective treatment plan.
So now we’re going to kind of talk about like how we use it within therapy. Some of these things kind of like go with what we’ve already mentioned, but I think it’s important to not only talk about like the why we use it, but then how. We use it in therapy and we might be crossing over with some things that we’ve talked about in a previous episode, but so one, I mean, obviously one of the first things, like we’ve said, is understanding the client’s needs, like you can’t really move forward with a treatment plan, like we’ve mentioned, you can’t really move forward with much of [00:35:00] anything if you’re not, if we don’t have a full understanding of, like, what your client needs to begin with.
John-Nelson Pope: Right.
Victoria Pendergrass: Right. So identifying like the framework understanding what the client’s symptoms are. And this is where, like, I think being open with your therapist and, and being comfortable with your therapist. Like I tell all my therapists, you can get a different therapist. If you don’t like who you’re with, that is okay.
You can find someone else who you feel like is a better fit for you. And that’s okay. Because I think then you’re going to be more comfortable to open up. About and then when we have all the information that we can get from you We’re gonna be able to provide a better diagnosis, which is then going to be able to Obviously help you in the long run
John-Nelson Pope: and it’s okay to disagree with your therapist.
Victoria Pendergrass: It is. Yeah,
John-Nelson Pope: very
Victoria Pendergrass: it is
John-Nelson Pope: Yeah, it is.
Victoria Pendergrass: Have you ever had anyone openly like
John-Nelson Pope: oh, yeah
Victoria Pendergrass: be like I don’t [00:36:00] agree with that Sorry, John. I like you but And I think that’s where we put fillers out, right? Like I might say something and I’m like, did that land? Like, was that, you know, was that a good analogy? Was that, you know, whatever.
And I’ve had people say like, yeah, no, that’s not a good analogy. And I’m like, okay, I’ll cut it out. But
John-Nelson Pope: you know, you, you are, are, Interested using diagnose and diagnosis properly is that you want to do the most good for your client. You want your client to get better. And so if they’re still miserable, you’re not in, you’re using the same old approach.
You might say, okay, well maybe. Maybe we need to reassess what the diagnosis is.
Victoria Pendergrass: Well, and one of our questions,
John-Nelson Pope: do your treatment,
Victoria Pendergrass: right? Yeah. One of our questions at the beginning is like, how does diagnosis influence treatment plan or therapy [00:37:00] techniques that we choose? And that kind of goes into the next thing we’ve talked about treat, like, treatment plans, but treatment planning also includes like different types of techniques.
So, like we said, someone for depression might benefit more from like cognitive behavioral therapy, CBT, or like mindfulness practices or different things like that, whereas someone with PTSD might benefit more from EMDR or exposure therapy or
John-Nelson Pope: cognitive processing therapy. There’s, there’s the, the, the thing too, is that
Victoria Pendergrass: oh, by the
Desensitization. Desensitization and reprocessing.
John-Nelson Pope: Sorry. I’m a, I’m a EMDR skeptic. Yeah. Yeah.
Victoria Pendergrass: But still like, I mean that the techniques I’m going to use in my day to day therapy with you is going to vary [00:38:00] based on your diagnosis. And if I am not able to give a proper, or at least what, you know, based on the information that I have a proper diagnosis, then the techniques that I use with you in therapy, you might be like, what, why is she doing this?
Like this is not effective. You know,
John-Nelson Pope: well, let’s use another example is sometimes there’s a borderline personality disorder.
Victoria Pendergrass: Yeah.
John-Nelson Pope: And that’s basically a, a core who you are as your identity. And
right.
John-Nelson Pope: Part of that is there has to be some sort of testing, reality testing that a person has. And so They have dialectical behavioral therapy.
Victoria Pendergrass: Right.
John-Nelson Pope: And to be able to put D-B-T-D-B-T mm-Hmm. . Yeah. And so that’s a, that’s a good way of and so you could treat depression, their depressive symptoms with it, but it’s very effective with ineffective effecti. Or effective. Okay. Effective. Yeah. Okay. So I think that’s, that’s [00:39:00] important that you have the right therapeutic model working.
Mm hmm. And to, so that their improvement can happen, uh, quicker. More rapidly. And I also
Victoria Pendergrass: think. And
John-Nelson Pope: permanently.
Victoria Pendergrass: And I don’t know, I might be off base here, so tell me if I am, but if I were, say, like someone was seeing you for a really long time and
you gave them a specific diagnosis and then for whatever reason, they moved, you moved.
whatever happened, they had to get it, got a new therapist. Well, typically they’re also taking their diagnoses with them. And so, like, the next therapist hopefully is still gonna do their own assessment and, like, come to their own conclusions whether or not they agree with Previous, previous diagnosis, but it kind of gives like a starting point of like where at least what, like some history as far as like what’s been there.
And I think that’s
John-Nelson Pope: why, why client notes are very important because the person, you know, the [00:40:00] person can the, he may have a, Let’s say the person gets the wrong, let’s say the therapist, we get it wrong, have the wrong diagnosis, but has excellent notes, then they could actually, the next therapist could see it and say, okay, well, this gives me some insight as to what is going on with this person.
So
Victoria Pendergrass: for sure.
John-Nelson Pope: Yeah, so I think that’s important. I think it’s other another thing and we don’t pull them in as much as we could, because I think sometimes people are,
Victoria Pendergrass: they’re,
John-Nelson Pope: they’re family members,
Victoria Pendergrass: pull family members and
John-Nelson Pope: pull them. Yeah,
Victoria Pendergrass: I mean, one of the things I used to really enjoy about working about doing therapy in the school system, like being a school based therapist, which for those of you who don’t know, and I’ve explained it before, but a school based therapist is someone who’s like, Embedded into a school full time typically or part time and they do just mental health therapy But in the school so like parents [00:41:00] don’t have to worry about driving their kids to therapy or whatever happens during the school day which can actually be very beneficial for like low income families people that have trouble like, you know
Traveling don’t want to take their kids out of school just you know to go to therapy or whatnot but I used to One of the parts that I used to really like about it is because I had access to so many people who had interactions with these kids.
So like say I had a fourth grader, well, like I could talk to their teachers. I could talk to their special, like their specials teachers. I could talk to the assistant principal or the principal, or, you know, if they had an IEP or a 504, like I could talk at so many people that, and I would try to do that every chance I got, like, You know, every time I had an assessment, I would try to go and talk to these people who had like these daily or weekly interactions with these kids just to give me more of a bigger, better picture of like what is coming from, you know, I’m not only talking [00:42:00] to the parent, but then I’m also talking to like, you know, sometimes not a lot.
I didn’t do this often, but sometimes I would like talk to their siblings and like, you know, talk about their relationship with their siblings and like. Get their siblings point of view, but definitely talk to the teachers like having access to all these people and I think that’s probably something I miss About being in here in private practices.
Not that I can’t do it It just obviously takes a little bit more effort and a little bit more work because I’m not in the school And
John-Nelson Pope: sometimes the client doesn’t want to involve. Yeah, and I think right
Victoria Pendergrass: So part of being a school based therapist is they signed paperwork so where I could talk to the teachers and everything without having to like get special clarification from The parents, but yeah, here, like we would have to get a ROI, which is a release of information form signs and the parent would have to be okay with us doing that.
But I do think that it could be used a lot more than the way that [00:43:00] we, what we do with it for sure.
John-Nelson Pope: They could be allies in terms of, of helping
Victoria Pendergrass: and
John-Nelson Pope: give further insight as to why the person maybe is acting the way they are.
Victoria Pendergrass: I mean, I’m even thinking I had a 20 to 25 minute conversation earlier this week with a parent about her son because they were about to have like a 504 meeting and we talked about like strategies that she can suggest for the 504 accommodations like for their coming meeting.
Okay. And
John-Nelson Pope: would you explain to the listening audience of viewing audience? Yeah. 504.
Victoria Pendergrass: Okay. A 504. I’m going to probably hopefully explain this to the best of my knowledge is a 504 is a a plan that can be put in place for kids who have Mental health or like behavioral health issues And struggles at school and then because of that accommodations can be put into place so for example [00:44:00] if You know someone is billy bob has a adhd diagnosis He can you know, they can apply for 504 see if Billy Bob meets the criteria, the qualifications for it.
If he does, then he can get access to accommodations, which might mean things like preferential seating in the classroom to help with focus. There we go.
John-Nelson Pope: And this is the, I think this is the key that we’re talking about. Diagnosis is very helpful. And
Victoria Pendergrass: like, he wouldn’t have access to that if he didn’t have an appropriate diagnosis from a mental health is
John-Nelson Pope: one of the things that I’ve, I’ve heard.
We’ve been able to, to help with diagnosis sometimes with I do a lot of social security disability and so in help them with that vocational rehabilitation, they don’t call it that.
Victoria Pendergrass: Yeah.
John-Nelson Pope: They changed their name, but
Victoria Pendergrass: even if you don’t necessarily, and that goes away into like college and grad school, you can have access.[00:45:00]
to specific accommodations if you have certain mental health or behavioral health like diagnoses. Well, the
John-Nelson Pope: ADA, too, is another thing, and a lot of times, unfortunately, the big organizations, they give lip service to people. to accommodations, but you have to go through all these hoops and it’s also very labor intensive.
And so, and you have to have a therapist that is willing to go and stick with it even for months to be able to do this. I mean, for
Victoria Pendergrass: this one student in particular, like I had to, you know, a letter about his diagnosis and about how I came to that diagnosis and blah, blah, blah. Like I had to put it all out on paper.
And obviously the mom was okay with me doing that and sending it. But you know, for them to like go into consideration for If I have a foreplay and which now this kid has [00:46:00] so, okay, we got other things like the big one goal setting that is how that’s how we’re using diagnosis and to create goals. Good old goals.
John-Nelson Pope: Did you say goals or goals? I’m goal. Oh, I’m teasing how you pronounce it. Goals.
Victoria Pendergrass: Goals. Okay. Don’t make fun of my. Goals. Accent. I know. Setting goals. Okay, what can you tell me about setting goals? John, and how we use diagnosis to do that. I
John-Nelson Pope: like to do, I like to set goals with the clients over a period of, of 12 weeks, 12 to 16 weeks, but sometimes it could be shorter.
We could do short term goals, middle goals, and long range goals,
where
John-Nelson Pope: you get there and you, and diagnosis is, for example, a person that might be having, let’s say they have. [00:47:00] Oh, I’m trying to think in terms of having anxiety.
Victoria Pendergrass: Okay.
John-Nelson Pope: Okay. One of the most, the, the gold standard for anxiety is CBT, you know, the Aaron Beck, you know, the, and cognitive behavioral therapy.
And it, there’s very different. A definite, a process that you do with a workbook
Victoria Pendergrass: or
John-Nelson Pope: you could use a workbook like the anxiety workbook. Oh, I
Victoria Pendergrass: have plenty of worry, worry, worry, worry, workbook for kids, but yeah,
John-Nelson Pope: yeah. Minor, minor for adults for the most part. And you can, it helps to, to set a treatment plan for them and helps them go and do exercises.
They have to do it with intentionality.
Victoria Pendergrass: Right.
John-Nelson Pope: And again, it’s what people don’t like doing and that’s homework. But usually I don’t,
Victoria Pendergrass: I don’t know, just a little tidbit here. I usually don’t call it homework. I call it usually like [00:48:00] exercises or practice. Or something along those lines so that it’s not like we’re not back in elementary school and I have to like complete this homework sheet or whatever.
But sometimes if I do, I don’t give it out a lot, but if I, like, physical paperwork, I don’t necessarily give it out a lot. I think people
John-Nelson Pope: will, will use their workbooks a lot more because then they won’t look at it as homework. They’ll look at it in terms of, uh, you’re participating and you go over it with them.
But the motivation is to get to have the person motivate to be motivated for it.
Victoria Pendergrass: Well, yeah. And I mean, you’re not going to have, or at least I would think you’re not probably going to have a goal of, I want to read 200 books in one year,
John-Nelson Pope: which you have,
Victoria Pendergrass: I’m almost there. I’m at like one 97. Right. Okay.
Neil don’t give me that look Okay, I might have a slight problem But anyways, like if I can’t I [00:49:00] don’t want to set that as a goal if i’m working if my
diagnosis or if i’m working on like Depression or if i’m working on, you know, like you want your goals to reflect You’re right. Like now the reason that I might be trying to read 200 books and one year might be attributed to the depression or vice versa, but like you want it to be relevant, you know, and that’s the whole, like, you know, we grew up with the whole smart goals or whatever, you know what those are?
John-Nelson Pope: No
Victoria Pendergrass: smart goals. Okay. Smart goals stand for like specific, measurable, attainable, relatable, and then like time, time management or whatever. And so like, yeah, you want your goals to be relevant to What, you know, what it is your diagnosis is, like, it’s got to make sense, you know?
John-Nelson Pope: This is one of the things in setting goals with somebody that is deeply depressed.
Victoria Pendergrass: Yeah.
John-Nelson Pope: Deeply depressed. The, they need to [00:50:00] get out and exercise. They need to go out and, and, and smell the fresh air. Yeah. And they, a lot of times they don’t do that. Yeah. Because they don’t have the energy.
Victoria Pendergrass: I’m like, yeah, they literally can’t get out of bed. So how
John-Nelson Pope: can you, how can you help them with volitional thing work?
Victoria Pendergrass: Well, and I think that can be maybe a goal down the line.
John-Nelson Pope: Right, right. But
Victoria Pendergrass: we gotta make it like smaller, more obtainable things to get there. Okay. I guess we need to go on. Okay. So we have also things like, and we’ve mentioned this, communicating with other professionals, so we won’t talk, you know, we won’t continue to talk about that.
Tracking progress. Like you can, like, measure improvement over time and use, like, diagnosis within that.
John-Nelson Pope: Right.
Victoria Pendergrass: Right.
John-Nelson Pope: So you can measure the symptoms and you can say, is there a decrease? With PTSD, they give you the, is it the PCL 5 or the PCL 10? Something like that. Basically like that, and I don’t need it, okay?
So. But yeah. So. Yeah. So and [00:51:00] you do that sometimes you can do it every, every treatment or you could, or every session, or you could do it every five sessions and you say, well, is this person having less post traumatic stress disorder symptoms?
Victoria Pendergrass: Right.
John-Nelson Pope: And, and so you, you can have it measurable. So that’s evidence based,
Victoria Pendergrass: but
John-Nelson Pope: at the same time it helps that person say, I’ve get, I’m improving.
Victoria Pendergrass: Right. Great points. Again, we have providing validation, which we’ve talked about, and understanding Also, I didn’t think of like access to resources. Again, we, I mean, we kind of mentioned that with like the 504, right? If you have a proper diagnosis, you might have more access to accommodations and things.
Get a person into
John-Nelson Pope: Voc Rehab, for example, would. would help them have more job opportunities or education opportunities.
Victoria Pendergrass: Yeah. And this is, we’re not just talking about like with, when you’re in like secondary, like school, we’re talking about like in your career field, like you might be able to access specific.
[00:52:00] Accommodations and specific thing resources. If you have a diagnosis that like supports that and backs that up
John-Nelson Pope: for test taking, that’s another one.
Victoria Pendergrass: Yeah.
John-Nelson Pope: For the GREs or the SATs
Victoria Pendergrass: or even things like the NCE, which is the national counselor examination, which we had to take so yeah, like an access to resources is going to be more of that.
Like. whether it’s community, whether it’s groups, whether it’s, you know, like, there might be certain groups. We talked about groups last week. You weren’t here for that, but we talked about groups last week. And like, you might be able to have access to being involved in more of like, a closed group if you have a specific diagnosis to like, you know, be a part of that group.
Okay. And lastly professional responsibility. And we’ve kind of talked about this throughout, you know, the ethical and clinical guidelines that we follow as therapists to document diagnoses, whether we’re filing it with insurance or whether it’s [00:53:00] someone who self pay and is not getting filed with insurance.
Like it’s our responsibility to
John-Nelson Pope: What’s our standard of practice. Yeah, to give
Victoria Pendergrass: the best care, and part of that best care is, giving like, the best availability in diagnosing. Right. Neil?
Neil Robinson: Well, we’ve had a comment from our stalker, I mean from Chris that says, One, he did start talking about changing things around, he said he’s, he’s, I have had people in therapy for a year and trauma has found thus the diagnosis changes to PTSD.
Yeah. So as you go in, you go one thing, you find out more history that changes. But then what kind of, we can probably close on this question from Chris, is diagnosis a science or an art?
Victoria Pendergrass: Ooh.
John-Nelson Pope: I think it’s. It’s both and I say because it’s statistics it’s data It’s accumulated knowledge, it [00:54:00] goes in there, but it’s also an art.
And so, so basically, I mean,
Victoria Pendergrass: there’s a reason we had to go to school,
John-Nelson Pope: right? And it’s practice and it takes a sense of, of nuance and that’s why we’re professionals. It’s not that we want to brag, Oh, look at me, I’ve got this degree or, but it is, we have. We have the training, the training and we’ve, we’ve learned and we’ve, we’ve had experience that would help us with, with doing this.
And so you can start to get a feel for diagnosis I think it was very hard for me to do diagnosis a long time ago.
Victoria Pendergrass: It’s not so
John-Nelson Pope: hard. Yeah, it’s very true. I mean, yeah, you just definitely have
Victoria Pendergrass: to have a comfort with doing it. You have to have the confidence that like goes with it and knowing that you’re making this decision.
John-Nelson Pope: And you have to, that’s right. And sometimes you’re, you’re, you’re backed up to a wall and sometimes the legal [00:55:00] system doesn’t always appreciate that. It’s right. Because I remember one of my first cases, I was called as a witness and determining with somebody’s, this is in Texas and determining whether that person is, is is a competent parent.
Victoria Pendergrass: Gotcha. Yeah. I mean, I would, I would definitely agree. I would definitely agree that with. and say that I think it’s both a science, but it’s also an art and like how you deliver it and like how you come to like what matches for each person. So I do want to end with again, reiterating that Diagnosis is not meant to label and while diagnosis is a useful tool, therapists often emphasize, or we as therapists often emphasize, that individual is beyond their diagnosis and focusing on the client’s unique experiences and strengths and personal goals.
Yeah. Any last minute?
John-Nelson Pope: Yeah. Mike drop. Yeah. You’re not your [00:56:00] diagnosis. Yes. You are not. You are you.
Victoria Pendergrass: You are you. You are John. I am Victoria. Neal is Neal. And Chris is Chris. And Chris is Chris. Okay. So. Remember, take care of yourself. Diagnosis is not a scary thing. And take it easy. Have a good week.
John-Nelson Pope: Take care.
Bye.
Victoria Pendergrass: Peace out.