Are you thinking about getting some psychological counseling, or, more formally, psychotherapy? When we use the terms psychotherapy or counseling, we mean the process whereby you visit a psychologist, psychiatrist, licensed mental health worker, or other professional, to help you with some emotional problems. The visits should include formal assessment and diagnosis of your difficulties, followed by treatment dispensed through regularly scheduled talk sessions—sometimes in combination with psychiatric medication—with the therapist, either individually or with a couple, family, or group.
An essential initial step in this process is the assessment and diagnostic stage. Because many people first see their primary care physician (PCP), they often receive a hasty, superficial diagnosis—a diagnosis not based on formal psychological assessment, but one amenable to drug treatment. Right away, we may have a problem. Even if the client eventually sees a psychologist, there is a major hurdle to overcome because the initial PCP subjective diagnosis—such as depression—may have been incorrect. This possibility can cause a great deal of confusion for the client, and one of the first hurdles for the psychologist to overcome is to help the client get over this confusion and consider the possibility of an alternative diagnosis. This process can be difficult, because once clients believe they are suffering from some specific problem—bipolar disorder, clinical depression, social anxiety, etc.—they tend to “buy into it,” accept the diagnosis and wear it like a name tag. The diagnosis can become part of their identity that helps define them (I’m an alcoholic, bipolar, depressed, borderline, etc.)
Comorbidity—which occurs often—is another problem for the diagnostic process. This term means that a person who possesses one psychological disorder has at least one other psychological disorder. Thus, many clients are treated by physicians or psychiatrists for one disorder, such as depression or anxiety, but do not diagnose and treat a comorbid disturbance such as a personality disorder. Comorbidity complicates both diagnostic and treatment issues.
Zach originally sought help after being forced to resign from his job for inappropriate behavior. A psychiatrist diagnosed his problem as bipolar and obsessive-compulsive disorder, and prescribed Depakote and Luvox. The medications did not help, but Zach did gain 120 pounds. He went to another practitioner who gave him a formal psychological battery of diagnostic tests. The test results were inconsistent with Zach’s earlier diagnoses of bipolar and obsessive-compulsive disorder. There was strong evidence of Persistent Depressive Disorder (Dysthymia) and borderline personality disorder. On the basis of these diagnoses, it was clear that the appropriate medications were not being prescribed nor was appropriate psychotherapy being used to address basic personality dysfunctions. Zach’s new treatment plan corrected these problems and he began to improve.
Thinking about getting some psychological counseling? Remember to insist on a professional diagnostic psychological workup to verify any subjective opinions offered by your practitioner.
Psychology and Stress 