Blog #5 (chapter 9&10)
These two chapters forced me to really wrestle with the idea of diagnosing clients. There are many dangers as well as limitations with diagnosing clients. Van Der Kolk spoke of the great power that they hold. To the point that insurance companies require some sort of diagnosis in order to receive diagnosis. On page 139, Van Der Kolk says, “a psychiatric diagnosis has serious consequences. Diagnosis informs treatment, and getting the wrong treatment can have disastrous effects. Also, a diagnostic label is likely to attach to people for the rest of their lives and have a profound influence on how they define themselves.” I’m not saying that mental health should get rid of diagnosis all together. I understand why they are necessary for insurance companies. I have some questions about unified treatment, but I think I understand some reasoning behind wanting a diagnosis for that. Beyond that, I’m not sure how necessary a diagnostic label is.
This past three summers I worked at a mental and behavioral health camp. Most of the kids that we served had a laundry list of diagnoses. Most of which were the ones that Van Der Kolk mentioned in these chapters: PTSD, oppositional defiance disorder, anxiety ADHD, reactive attachment disorder. Many of these diagnosis, I believe, simply have come from the complexity of a trauma on the brain. But, I don’t blame counselors because they are forced to place them into a diagnostic category in order to provide care. I’ve seen some of the difficulties Van Der Kolk was explaining in practice. I’ve heard the children I work with in the summer identify who they are by their mental health diagnosis. It is slowly becoming a part of who they are, and it is saddening. I, also, see the dilemma that the counselors face. In order to get reimbursed by insurance and as a requirement of most practice, they have to diagnose a child with something. I know it is much more complex than I’m making it seem, but it just seems like the system could do better.
I think Van Der Kolk hit the nail on the head when he talks about how complex trauma and its effects on the brain. The symptoms of complex trauma are similar to many mental health diagnosis, but don’t fully reflect any mental health diagnosis. My aunt has experienced this with my cousin I talked about in my previous blog. They’ve seem multiple specialists and counselors, and they’ve given him so many diagnoses that don’t do justice to his unique struggles. My aunt talks of her frustrations that doctors will just look at symptoms without any history and diagnose rather than seeking to understand that he’s experienced major trauma.
Abby, I also struggled with the idea of diagnosing clients and similarly to you, I see both sides. In order to receive services at my current work, a child must have a severe emotional disorder or SED. One thing that I do appreciate about my work is that they do not put a diagnosis on someone simply because. For instance, I have a 2 year old client who is on my caseload and he qualified for services due to a therapist using a Z code. He was not put under the umbrella of a disorder such as anxiety, but Z63.5 which is disruption of family by separation or divorce. I thought this was very fitting!
ReplyDeleteDid you encounter any stigmas from other staff regarding the children's long list of diagnoses? By chance is this Royal Family Kids Camp? I agree that we need a unified approach with treatment. But how do we get there?
ReplyDeleteI'm glad you've been able to see how the system "works" in regard to diagnosing and getting treatment. The DSM and medical model pretty much dictate how we operate in terms of having to give people a diagnosis, even if we may know that the symptoms they are presenting with don't align with the underlying issue. It would be nice if there were more diagnoses which point to the nuance of trauma. For example, depression stemming from trauma, anxiety with trauma history. The current way we write up our diagnosis does allow for some narrative, still there is a set amount of structure in terms of the codes we give them.
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