Therapists are clinicians and can diagnose many mental health conditions. If they are not trained to diagnose a specific condition they may refer out for a diagnosis if there is a benefit to that. (For example, my therapist suspected I might have ADHD and referred me out to talk to a clinician who is trained in diagnosing ADHD and is able to prescribe for it if necessary.) You do not need to go to a psychiatrist for a diagnosis of many mental health disorders.

I think this is an excellent question. My T and I don't dwell on diagnosis and he doesn't talk about it to me. I don't think it would benefit me to have a label or think there is something pathological about myself. My T focuses on health rather than pathology. People can feel stigmatized by a label or start focusing on all that is "wrong" with them rather than developing further all that is positive about themselves and that they have potential to be. Also, if a client is focusing on a diagnosis, they can use that as the explanation for their symptoms and develop a fatalistic view, e.g. "I am emotionally volatile because I have histrionic personality disorder, so therefore, there is nothing I can do to change that about myself" and they won't work on trying to overcome their dysfunctional behaviors.

Even if a T doesn't talk about a specific diagnosis with you, he may have something in mind because it could help guide what he does with you in therapy. For example, my T and I did a lot of trauma work early in therapy and he probably thought I had PTSD--I think he mentioned it once after we were done with the trauma work. But it was never necessary for him to come to me before or during treatment and say "hey, sunrise, you have a diagnosis of PTSD." He just said we are going to use these techniques in therapy because I think you have experienced some traumatic events and that is causing you difficulty today. Let's try these techniques and see if they help.

I don't think his style of therapy--not emphasizing a diagnosis even if he has one in mind--means he is patronising you. It could very well be a positive thing that he does deliberately. I have never felt patronised that my T doesn't focus on pathology. I feel empowered because he focuses on health. If you are feeling patronised, though, then I think it is important to let your T know how you feel. It could harm the therapeutic relationship if you feel this way so addressing it directly with your T could help.

Talking to him would help you understand why he does therapy the way he does, and let him know how you feel. It would help your communication and your relationship, help you understand why you want a diagnosis and help him understand that too, and perhaps give one to you if it seems like it would benefit you. I don't see any down side to talking to your T about trust.

Good luck. Hope you will check back in and let us know how it is going.