Can a Therapist Diagnose Mental Health in the Heat of Relationship Crisis?

Would a good therapist diagnose someone's mental health when they are having severe problems with their significant other (SO)? The answer is more nuanced than a simple yes or no. Factors such as time scale, the ongoing nature of the problems, and context all play a crucial role.

The Role of Therapists and Psychiatrists

The differences between a good therapist and a medical doctor, such as a psychiatrist, are significant. Psychologists and therapists, while trained to diagnose psychological issues, do not place the same weight on formal diagnoses as medical doctors do. Instead, they focus more on the well-being and happiness of the individual, as well as the effectiveness of the therapy.

Think of it this way: a psychiatrist is trained to solve problems by determining diagnoses and providing treatments. They have the answers and are trained to provide quick diagnoses. However, psychologists take a more holistic approach. They know that the right therapy can lead to improvement, even if the diagnosis is not entirely accurate. They prefer questions over definitive answers.

A Real Case Example

Consider my experience with a young man who was diagnosed with OCD. While he was certainly compulsive and had some rituals, as I got to know him, his diagnosis began to change. He had a poor sense of identity, was fearful of abandonment, and had been abusing drugs. He had also engaged in self-harm by cutting his arms and upper legs.

At first, therapy focused on self-calming strategies, learning and practicing interpersonal skills, and a bit of cognitive reframing. There was little mention of OCD. In my notes, I added a question mark and wrote, "r/o BPD," which stands for "maybe Borderline Personality Disorder," a condition that often co-occurs with unhealthy relationship patterns.

Therapy and Function Over Diagnosis

What's more important in therapy is the improvement in function and overall happiness, not adherence to a specific diagnosis. The therapy we created together, addressing his concerns and needs, ultimately helped him. The diagnosis of OCD was less relevant than the strategies we developed to help him manage his emotional state and interpersonal relationships.

It's important to note that therapists do not take diagnoses as seriously as medical doctors, who are trained to make quick, accurate diagnoses. Context, personal history, and the unique circumstances of each individual are too important to be overlooked. However, there are important exceptions, such as when medication is necessary for conditions like bipolar disorder or psychosis.

In my practice, I used to receive third-party reimbursement, and there were specific guidelines I had to follow to document diagnoses according to the DSM (Diagnostic and Statistical Manual of Mental Disorders). But in general, I believe that people often give too much weight to formal diagnoses and not enough to the overall well-being and functional improvement of the individual.

A Final Note of Caution

Dr. David McPhee, the author of this article, does not provide any psychological or health-related services or advice to individuals on platforms like Quora. His responses are for general information only and never constitute advice for any individual. He uses fictionalized case studies to teach, reassure, comfort, and challenge while ensuring the privacy of his patients.

For anyone seeking professional health advice, it is crucial to consult with a licensed mental health professional. These professionals are trained to provide accurate diagnoses and effective treatments based on the individual's unique circumstances.