A diagnosis does not define who you are,
or will become...
What follows is a collaboratively produced diagnosis disclaimer that I use in my informed consent. Truly giving informed consent in a relationally ethical way means explaining what diagnosis is and that it is required and what the potential effects of having a diagnosis may be. This was first created in my Advance Narrative Practice Group at Evanston Family Therapy Center under the mentorship of Jill Freedman and Gene Combs. Members of the group who created it, included: Suzanne Gazzolo, Matthew Mooney, Tzu-Ping Cheng, Timothy Corvidae, Josh Mark, and Jason Kae-Smith. It has been molded and updated and passed around. This version is my own most recent version. We share this widely and generously and ask that
you cite the path from which you received it and give credit to this group of narrative therapists. Thanks!
III. Diagnosis, Prognosis and Alternatives to Treatment
Disclaimer: A diagnosis does not define who a person is. It is a particular kind of, singular, overly simplified description created at a specific moment in time to depict actions and effects but does not explain how they came to be. Mental Health diagnoses are different than other medical diagnoses in that they do not represent proven organic pathology. Diagnosis is a shorthand method of communication among clinicians and businesspeople used for classification and insurance purposes and should never be used to define a person or their worth. Diagnosis can have effects on future employment opportunities, or ability to gain employment and other potential effects and therefore should be done with great care. Clinicians, businesspeople, and all involved in therapeutic consultation should actively challenge the ways diagnoses limit perceptions of people; and strive to situate diagnoses in context while adding complex descriptions of the person that include skills and abilities.
I am required by the ethical code of my licensing board and insurance companies to select a diagnostic code to put in your file. Third party payers, such as insurance companies, also require diagnoses for coverage of your costs. I will collaborate with you on your diagnostic assessment and diagnosis, asking about pre-existing diagnoses, and explain fully what the diagnosis is and means. All of the diagnoses come from a book called the DSM-V; I will have a copy available for you to look at if you want to learn more about what it says about specific diagnoses. This book is essentially a categorical system (initially intended as a reference book); a book of ahistorical, a-contextual lists of symptoms that are remarkably similar across so-called diagnoses; with very little acknowledgement of trauma and its effects across a wide range of so-called mental illness. Distress and suffering are real, and they exist for a reason. It is my preference to assess distress, unusual experiences, and problematic behavior (as defined by you and your family/community) through the lens of “What happened to you?” rather than, “What is wrong with you?” as the British Psychology Society and Division of Clinical Psychology suggest in their Power, Threat, Meaning Framework, as it takes a systemic, contextual, historical view of how power, and things like trauma and attachment may be contributing to problems rather than locating the problem solely in the individual. I believe that problems are problems; people are not problems; and use diagnosis only as necessary and keep the focus of our work together on you as a whole person.
And a short version for my email signature...
A diagnosis does not
define who you are,
have been, or will become...