Should Psychotherapy Patients Know Their Diagnoses?
Ostensibly protective, not sharing diagnoses is anything but helpful.
Posted Jan 14, 2021
Not long ago, a supervisee asked if it was kosher to disclose a psychological diagnosis to a patient. An ages-old debate, I helped her arrive at her own conclusion for her situation. I must admit, however, I have always felt perplexed as to some practitioners' resistance to sharing the clinical term for the patient's experience.
Arguments against diagnosis disclosure
Much has been written about the alleged damages of mental health diagnosis/disclosure. The two primary arguments and their reasoning I've heard over the years are:
1. The patient takes on the label
Patients may feel it defines them, leading to shameful self-perception, or a need to maintain the symptoms for self-identity. Other times, they may capitalize upon it to make excuses or justify behaviors.
2. Diagnoses are stigmatizing
Stigma is driven by grossly-inaccurate understandings of mental illness in popular culture. Patients may be crushed to hear they are "one of those." Practitioners may fear that if a particularly scarlet-lettered diagnosis, like a personality disorder, is applied, the person could share it with others and be further alienated.
The irony of the arguments
- By avoiding talking about their diagnosis, is it not contributing to the very stigma that keeping mum is allegedly protecting them from? It sends the message: "Having a mental health diagnosis isn't pretty."
- We are supposed to essentially deny someone has the condition that we are nonetheless treating because it may be incorporated into their identity. Even if they don't know their diagnosis, could they not also incorporate into their identity "I see a shrink?", thus also implying mental defect, and leading to shameful self-perception? It's not so much diagnosis, it's the more global matter of mental health care still being stigmatized despite its rising popularity over the past two decades.
- Why would it only be psychiatric diagnoses that negatively impact patients' self-perceptions? If diagnosis was so damaging and stigmatizing, why not withhold STDs, HIV/AIDS, obesity, and substance abuse diagnoses, all perhaps just as stigmatizing, or more, than mental health conditions?
- Many people have a fallacious idea of their diagnosis from pop culture's erroneous representations, non-mental health practitioners, friends, or internet searches. I have met my share of people convinced they have a serious mental illness from the aforementioned sources, like bipolar disorder, schizophrenia, or OCD. Some have anticipated a future of significant psychiatric medication, or landing in a program where their life revolves around exposure therapy exercises for months on end. Is it not more ethical to inform them of their actual diagnosis, erasing the impending doom, and giving them accurate information on prognosis and treatment?
- Lastly, depending on insurance companies, many patients receive an explanation of benefits (EOB), from which they could easily obtain their diagnosis. They can also simply call their insurance provider. Such a cat-and-mouse game doesn't do much for trust in a therapeutic relationship.
What this means for the therapist
It is equally important to consider how not disclosing it could impact them/your relationship.
If a patient pointedly asks for their diagnosis, it is likely more than curiosity. Imagine a patient with a problem they've never encountered before who feels they're losing their mind. Knowing what's happening to them puts the puzzle together, providing a clearer understanding of themselves, and comfort in that it's a known and treatable condition.
Have you or a friend/loved one not had a frightening medical experience only to feel relieved when it was named? You likely no longer felt alone and became hopeful of its resolution. This is therapeutic unto itself, as the not knowing what's happening compounds their stress.
If you need further evidence of this, look no further than Kiera Van Gelder's book The Buddha and the Borderline. Her proper diagnosis was withheld from her for years. Van Gelder explains how this led to prolonged misery in terms of not knowing there were others in her position she could identify with, and not knowing what proper care was in order to seek it when other providers weren't helpful.
It may be appropriate to offer the correct diagnosis, especially if they have themselves misrepresented. A patient has a right to know about their condition in order to self-advocate or to ascertain if they are receiving the proper care.
The National Alliance on Mental Illness (NAMI) makes it a point on their website to note the importance of discussing diagnosis with their provider:
"Even though labeling your symptoms doesn't automatically relieve them, congratulate yourself on having moved forward in the process of getting treatment and protecting your rights [italics added]."
Ultimately, it isn't so much about "should a patient be told their diagnosis?" Perhaps it is more important to consider how it is explained to them that dictates if it affects them, good or bad. Learn some how-to tips in the following post, How to Effectively Discuss Diagnosis With Patients.
This post also appears on Psych Central.
National Alliance on Mental Illness. (2020). Understanding your diagnosis: why diagnosis matters. https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Understanding-Your-Diagnosis
Van Gelder, K. (2011). The Buddha and Borderline: my recovery from borderline personality disorder through dialectical behavioral therapy, buddhism & online dating. New Harbinger.