Diagnosis

I started therapy last september and was with exT through the end of november (ended in abrupt termination because of transference issues). This february I started seeing current T once weekly. Neither of them have offered a formal diagnosis. Is that standard practice? Do I have to ask? If so, how do I bring it up?

A lot of Ts aren't very big on labeling with a formal diagnosis. I saw mine for 6 months before he said anything and the only reason he did was because my insurance company is doing a case review and he wanted to let me know what he was going to tell them.

If you want to know, I'd just come right out and ask - "I'm curious - what do you think my actual diagnosis is?"

yeah i think that's standard. i've had a few T's and none have given me a diagnosis. i think that's mostly the remit of psychiatrists.

from what i know though it's often better not to have a formal diagnosis on your medical records. especially if it's something with stigma attached like bpd.

in the past i asked T's what they thought my dx would be. one refused to discuss it- not big on labels. but my current T doesn't mind discussing it because i'm a program for bpd so it's not exactly a big secret

If they are filing with insurance, there has to be a diagnosis code on the paperwork. If you are paying out of pocket and not filing, the diagnosis code isn't required obviously.

That said, my T uses one diagnosis code, and my pdoc uses another, so I don't put a whole lot of weight into that necessarily, but it would be a place to start. Just ask your T what he feels your diagnosis is. It isn't a secret between you or anything. Be prepared that he may not offer you one. Some T's don't "believe" in diagnosis (whatever that means). But even then, he should be able to describe to you what he sees as your symptoms and patterns even if he refuses to put a name on that for whatever philosophical reason he has.

I haven't wanted to be diagnosed so I haven't asked and none of my t's ever exactly offered. Some of them in the past discussed what they needed to put down for insurance purposes. Now I just tell them I'm coming to therapy for depression when I start, and they go along with it. I say depression since I know it's considered an acceptable reason to be there and they can put it on the insurance if they need.

Im a psychology student and I have symptoms of many different diagnosis that range from anxiety, personality disorders, asperger syndrome, dissociative disorder, etc... I get really curious about what she is trying to diagnose and/or rule out when she starts asking a bunch of questions and writing alot of info down in my file. Id love to ask to see her notes I know I have the right to see my medical records, but im afraid to ask her while im still in therapy. Ill definately ask for my records post-therapy.

Don't be hesitant to just ask what she is seeing at this point. I'm sure she would be quite will to discuss it with you, even if she hasn't come to any solid diagnosis yet. My T and I talk diagnosis from time to time. It's usually quite interesting and enlightening.

If this was a medical doctor, you'd certainly feel free to ask what your diagnosis was or what the doc at least suspects could be the problem. Of course, even medical doctors may tell you they aren't sure, but usually they have it narrowed down somewhat. That's how they make their treatment decisions. Talk to her about it.

I asked my T about this and she said that not all insurance companies (including mine) require a diagnostic code. Since I do not have a diagnosis, she said that she does not have to "make one up" in order to bill my insurance company. My insurance simply covers therapy without any limitations (at least not any that I've come up against).

If you don't mind me asking, what insurance do you have? Mine is Blue Cross Blue Shield.

Most do. Yours in not the usual. Since therapy is being reimbursed by medical insurance on usually a medical model, they justify reimbursement by there being documentation that there really is an "illness"/condition that they are paying for. We may not like it that way. We not feel we have an "illness", but if we are using "medical" insurance to pay for our therapy, they generally require a medical reason for treatment, and the DSM codes are what they rely on for those justifications. Many therapist will use a fairly general code like adjustment disorder or depression to satisfy the paperwork, but even that isn't always enough. Insurance is such a huge business and they are there to make a profit as their first priority. If they don't have a medical reason to justify handing over their money according to their rules, they generally won't pay. Yours is truly a pretty rare insurance situation anymore; hang onto it.

This is so true. My insurance covers unlimited therapy visits (with a co-pay). However, if you go over a certain number (which they won't divulge) or see your T more than once/week, they start a case review. Basically, that's where they pry into the details of the therapy and the patient and decide whether or not the therapist is correct. If they decide T is wrong, they stop paying.

Like some nurse who doesn't want actual patient contact anymore knows about me, my therapy process and psychology overall better than the PhD psychologist who's been treating me for 6 months and knows more about me than anyone else on earth.

Yeah, I'm a little bitter about it...

I asked mine & kind of shrugged and told me. He acted like it wasn't a big deal.

Therein is the rub. A diagnosis is just business as usual for a pdoc or therapist. They deal in those terms all the time and probably don't have to apply a great deal of deep thought to it most of the time. For us, it leads us to places we need to explore and things we need to learn and affects perhaps our perceptions of who we are; much bigger deal from our perspective and much more foreign to us at the beginning because most of us don't have the education/knowledge about our diagnoses that are pretty automatic for our T's and pdocs. They forget that at times. Sometimes we have to remind them to get back down to our level.

I fall under the parity law, so t is unlimited, but T still needs a diagnostic code. Pdoc and T have different dx's though. Pdoc sees all organic illness, T sees it as all trauma. Ask your T if they use a dx code and if so what it is.

My T needed to put a diagnostic code for my insurance. He used anxiety. When I questioned him on it he said its obviously much more complicated but he had to put something down. I have PTSD/Bipolar...he agrees but I don't know if he ever changed it. That's my pdocs current Dx.

Update: I saw T yesterday. We were talking about my inability to make/maintain friendships and how my anxiety and lack of communication skills and lack of interpreting social cues are affecting me. I was frustrated and said something like "i hate being abnormal, whats wrong with me!" then I glanced at T and she gave me a empathetic look and started explaining that I might be borderline aspergers. Wow such a relief to at least have an explanation as to why I am the way I am. she said she didnt want to mention it sooner because she was afraid id get more frustrated and depressed. Now starts the process of finding a T who specializes in aspergers or autism spectrum disorders. And T thinks I should accept the fact that I may never be as social as most people

So glad you at least feel like you have a place to start looking. Let us know what you learn as you go.

nobody can predict your future. You do need to accept how you are now, but the possibilities of who you may become are endless.

My t is a clinical psychologist who tests and diagnoses all of the time. I was a bit irritated that she came up with bipolar 2 for me. When I went to my pdoc and had 2 hours of physical and mental testing the diagnosis was...bipolar 2. Should I go for a third opinion?

I think there is pressure in our society for people to be extroverts and social. I don't have Asperger's, but I am an introvert and have accepted that about myself. It is nice not to continually feel I am deficient in some way because I'm not society's ideal person. So I do think acceptance can be very helpful. Skills are helpful too.

My T hasn't given me a formal diagnosis, but has mentioned informally a couple of times about PTSD. This idea helps guide him to choose trauma treatments for me. I have other stuff going on too, and he did refer me out for ADHD assessment because that is not a diagnosis he makes. If he suspected something required medication, my guess is he would refer out.

I have another provider who prescribes for my ADHD. In order that I be allowed to take 2 different meds for this, she has to assign me another diagnosis, so she gives me Major Depression. I'm not depressed, though. It's so stupid! It's a game they play so that the patient can get the treatment they need and the provider can get reimbursed.

A family T I went to with a family member gave me a diagnosis of Adjustment Disorder, but my understanding was that this was the most benign diagnosis he could assign and still get compensated. Most insurance won't reimburse for family therapy (when there is more than one client in the room).

I used to want to have a label, but my T discouraged me from this. I now think that was good advice from my T - although my head still gets to that place of self diagnosis sometimes.

Diagnosis may become more important when medical treatments are to be used, trial and error has taught physicians that x works well for B, but not so well for C etc...

But otherwise I think it is like saying "I have a headache, what's my diagnosis?"
Answer = "you have a headache". So in other words, I think what is more important is symptoms and our reaction to them and how we can learn to manage them differently.