Diagnoses, Therapy, and the Person That Sits in Front of You

I have a client right now who reminds me of a lot of the other clients that I have had.  He is one of many with a severe trauma and abuse history.  After seeing countless kids, teens, and adults with similar backgrounds, you almost start to think that this sort of life must be normal.  But you have to remind yourself that it is anything but.  I especially feel for some of my younger clients who have had such an unfair start in life.  As clinicians, we are quick to put labels and diagnoses on a problem when half the time, clients’ experiences with these things and current symptoms have served a purpose.  If holding onto depression,  anxiety, PTSD, or some sort of attachment problem serves a purpose (which they all do), we have to be careful not to pull that immediately away.

What’s always troubled me more than a “typical” Axis I disorder is any of the personality traits/disorders you get on Axis II.  It bothers me that we already start putting down things like “Borderline Traits” in a teen’s medical chart.  Who knows how long some of that can follow someone? Most teenagers are still figuring out who they are and their place in the world, many clients have the added burden of just trying to make it through each day given the experiences they have been through.

I don’t think it inaccurate to describe what you see but the trouble with diagnoses is once it’s written in a client’s chart, it starts to form your impression of someone before you’ve even met them.  It becomes hard NOT to see them through that lens.  And I don’t like that.  It makes us as clinicians anything but impartial observers to the clinical picture we see.  We might then behave in ways that serve to mold and reinforce the very same behaviors we are pathologizing, albeit unwittingly.

I am not sure of any particular miraculous way to fix this, I just find it unfair to be imposing so many labels and disorders on clients so young.  Even my first practicum in the Master’s program, that was on a dual diagnosis inpatient unit (substance abuse and mental health), I remember hearing some of their stories and thinking “It’s amazing that they’re even still standing here today.  The fact that they even made it another day and are here in this moment is remarkable.”  I guess what I’m saying is it’s also important to remember a client’s strengths and not be too quick to see them as the sum of their history and “problems.”  Given some of the stories I have heard over the years, I am not so sure I would have done any better myself.  Sometimes, it’s amazing that that person got out of bed and made it to your office that day.  Let alone the fact that they were willing to share a little bit of their world with you.  I don’t ever want to forget that or take for granted the special gift that that is.  Someone is trusting me with one of the most precious parts of themselves and I am privileged enough to be able to hear it.


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