Can LPC's diagnose?

Can LPC's diagnose, or do I need to go to a psychiatrist for that?

For some reason I'm obsessed with having a diagnosis of what's "wrong" with me, but I'm not sure my counselor will/can do it.

I went to a psychiatrist a few weeks ago and she prescribed Zoloft and Xanax for my anxiety problems. After a week the Zoloft made me so sick I had to stop it and she said just take the Xanax as needed.

Is it important to have a true diagnosis, and if so do I need to go to the psych for that?

Any therapist/counselor can diagnose, the diagnosis is for the therapist, to help them help you. If you want to know what you're being treated "for" just ask your counselor and discuss it with her. There's no such thing as a "true" diagnosis as it depends on who/why/what the person diagnosing you is "doing" with the diagnosis.

Obviously you have an anxiety problem; why do you care if it's panic attacks or GAD? Work as best you can on it with your counselor and take the Xanax as needed. Your counselor might be more interested in your "obsession" with wanting a diagnosis. What would having one mean to you?

I have an obsession I think with thinking I have some disorder. . .like do I have bi-Polar, or OCD, or do I have some sort of dissociation disorder.

That is an interesting point. Why do I keep doing that?

I guess I want to always be able to say "is this normal?" and if I have a diagnosis, I can at least say whatever weird thing I'm doing or thinking is normal for someone with . . .X.

It is important to have a diagnosis if you need your health insurance to pay for your treatment and your health insurance won't do that without a diagnosis.

That is about it in my honest opinion.

Current DSM nosology (and ICD for that matter) lists behavioural (including verbal behavioural) symptoms. If you meet however many out of however many symptoms then congradulations you fit into that diagnostic category. Diagnoses don't *explain* why you have the symptoms you have. Diagnoses (in my honest opinion) really aren't good for a whole heap except as a pre-requisite to get certain kinds of treatment.

The major drive behind the DSM listing more and more and more diagnoses with each edition isn't to do with good science or descriptive adequacy or with providing a better tool for research. The major drive behind the DSM listing more and more and more diagnoses with each edition has to do with politics. In particular, politics around what health insurers will and will not provide for.

Sometimes people come to internalise their diagnostic category. They read about 'typical people with diagnosis x' and they come to... Well they come to behave in such a way as a matter of self fulfilling prophecy. The looping effect of categorisation...

That is why the worst prognosis for schizophrenia is living in an industrialised western country. People in other cultures do much better with recovery. In western society, however, we like to tell people they are 'chronic', institutionalise them, stigmatise them, and drug them off their faces.

IMHO diagnosis doesn't matter unless you have to deal with your health insurance company.

Regarding medications... Medications work on symptoms not on diagnostic categories. That means that diagnosis is not relevant for medication, it is the particular symptoms you are experiencing that are relevant.

Using a diagnostic category to *explain* symptoms is like this:

Q Why does the drug put people to sleep?
A Because it has sleep inducing power.
(Problem: We only say it has sleep inducing power BECAUSE it puts people to sleep thus we have a CIRCULAR explanation)

Q Why do I have these symptoms?
A Because you have this diagnosis.
(Problem: We only say you have that diagnosis BECAUSE you have those symptoms thus we have a CIRCULAR explanation)

Of course some people find it helpful to know there are other people like them and they are not alone. In my honest opinion one can meet other people with similar symptoms across a whole range of diagnostic categories and all diagnostic categories really do is confuse the issue... Oh and make a lot of money for the American Psychiatric Association, of course...

I'd list your symptoms (aka the problems that you are having that you would like your therapist to help you with).

e.g.

mania? (how bad is that?)
depression? (how bad is that?)
obsessions?
compulsions?
etc
etc

you know other people have those symptoms already...

yeah you may be right. The more I get out there and find communities of people with various mental healt issues, the more I realize that I relate to a lot of them.

I do have a problem with obsessive thinking, however not the compulsive part (unless you count searching the internet a compulsion. . . which maybe it is) and I don't do things to keep a bad thing from happening, I''m just always searching for an ANSWER and thinking through things in my head, planning out conversations as well as replaying conversations in my head. That's my obsession "stuff" and it keeps me awake at night.

I have a problem with dissociating sometimes. During labor it came in very handy but it doesn't always come in handy at other times when I'm shutting off my feelings and then all the sudden I realize I'm doing it. My husband tells me he can tell when I sort of "check out" and I get really annoyed when I'm in a zone and someone tries to make me come back to the moment. I want to stay alone in my head.

I have a problem with mood swings at times. I get irritable sometimes and I can even be a bit manic at times, and my counselor says I'm doing the manic activity thing as a way of dissociating from my feelings and things going on in my life that I don't want to face.

So there are tons of people like you say that I can relate to, and maybe I am looking at this in the wrong way. Maybe I don't need to be diagnosed.

The truth is I grew up in an alcoholic, abusive home, and I have a bad image of myself as well as assuming everyone else has a bad image of me.

My cousin tells me. . . you don't have to label it, it's just you.

And as for internalizing diagnosises, I am 100% SURE I would do that, so you're probably completely correct that I should avoid that and just work on getting to feeling better.

Thanks for the feedback. You have helped me more than you can know.

Thats ok sweetie...
Ever since I was a little kid I knew there was something wrong...
But I didn't know what it was.
I used to ask 'what is wrong with me? what is wrong with me?' fairly compulsively.
Then, after my first contact with the mental health service I figured the answer would come in the form of a diagnosis.
I was always pushing my clinician's to tell me what diagnosis they thought I had. They were reluctant to tell me. They kept trying to divert me back to my symptoms. But I wanted to know and they had to put it on my file in order for me to obtain treatment, you see.
Once I found out I read everything I could get my hands on and... I had trouble with how to view myself. I started viewing myself through the lens of what had been written about my diagnosis. Only... I disagreed with some of it. I battled for a long time in the position where if I were to internalise all of it I really thought I was obligated to kill myself to save others from my harming them. So I'd swing to denial but lived in fear that I was in denial because I couldn't face the truth.
But it wasn't the truth. Wasn't even. What clinician's write about people with x diagnosis reveals just as much (if not more) about them and their issues.
The whole process was really very harmful to me.

And now... Looking back... I can see why. I really wish that someone had sat me down and said this to be before and saved me a lot of grief. Still... I usually do have to learn the hard way...

For me... Part of it is about how to view myself. A diagnostic category gives me a conception to run from. A conception that I'm going to... Spend my life trying to counter and avoid and not be true to.

What I started to do was to write down the kind of person I'd like to be. The qualities I'd like to nurture. That is a self conception to work towards rather than a self conception to spend ones life running away from. Your symptoms are the things that are holding you back from achieving your self conception.

Looking at it that way helps me be a whole lot hopeful...

Also...

It is controversial but the DSM is looking at moving to a dimensional rather than categorical approach of mental disorder, particular kinds of mental disorder, and symptoms. While the categorical approach seems to suggest that there are real divisions in nature between disordered and not disordered, between diagnosis x and diagnosis y the dimensional approach suggests that there aren't real divisions instead it is all a matter of degree.

I have friends who have never been in contact with the services (and they probably don't need to) but they have traits that (if magnified just a little) would see them meet criteria for something or other. Everyone has elements of obsession and dissociation and mania etc etc. It is just the degree to which the symptom is present that can lead to problems with respect to your being the person you want to be and living the life you want to live.

Yeah truly the main point is to be able to relax and be at peace with myself, enjoy the moment, and be a loving productive person.

Where can I sign up for that?

My counselor and I have been talking a lot about this approval thing I have. And since we're both Christians we have been talking about how God loves me and that's fine, but it doesn't make me feel less hurt when someone else doesn't like me.

He was telling me that I needed to take the eggs out of the basket of people that i'm always trying to please, and put them in the basket of God loves me, I'm a valuable person, and should just feel secure in myself.

I told him I'd be happy for him to just move those eggs for me right now and we'd be all set. :-)

This feeling that there is something terribly broken and MESSED UP about me, and that people that are nice to me are only being nice to me for a reason other than who I am, and I try to get the people that really just don't like me to be nice and like me. . . is the biggest part of my problem.

And I was telling him how wonderful it is online when you find someone who has the same problems or even hobbies (in a positive light) as you do, and you can just focus on common ground and leave the rest out. . . and that's why I'm so addicted to the internet (and probably why I want a diagnosis)

Again thank you. I'm feeling an enormous weight lifting from me just thinking this way. I've been terribly absorbed in this the last few days and I'm sure that energy could be much better spent on flopping down on the floor and playing "littlest pet shoppe" with my kids.

> Yeah truly the main point is to be able to relax and be at peace with myself, enjoy the moment, and be a loving productive person.

Awesome! Your t should be able to help you out with relaxation techniques... I've found mindfulness meditation to be about perfect for fostering those kinds of things (they are all part of who I want to be as well)

:-)

Sounds like you had a hard time of it as a child. That your parents were focused on themselves and their own hurts and you most probably didn't get the attention and acceptance that is optimal for a developing child. I think that the acceptance and self love and self confidence thing develops because our parents accept and love and have confidence in us. Then we internalise their conception of us. But for those of us (I think there are lots of us out there) we didn't get the care and attention we needed as kids. And so we didn't internalise this wonderful positive conception of ourselves. Instead... Sometimes parents can say hurtful things or disregard their kids needs and stuff and so sometimes we internalise this hurtful critic or something like that.

Having a conception of God as someone who loves and cares for you should help... But having a therapist as someone who gives you care and attention and who has confidence and faith in you should help you too. You get to see him caring for you and as you start to internalise that...

I think sometimes that that is how therapy helps. When people had unhappy childhoods and stuff...

Sometimes the problem is that we weren't nurtured adequately as children.

And that manifests in a variety of symptoms... And how to categorise / classify them...

But of course I'm picking something and running with it to even suggest this... It is just that I think that my bad feelings... My panic and upset and distress and what it is that is really holding me back.... Is feelings like guilt and shame and inadequacy and that I must be unloveable because... I didn't get adequately nurtured because my parents were focused on their own problems...

ugh. sorry about that
(me me me)
glad you are feeling better
(hope i didn't just wreck that)

yeah, go play with your kids ;-)

(i guess i was attempting to normalise the feeling of being irretrevably broken and i wanted to say that i think that can indeed get a whole heap better over time. and that if you look at your childhood... it really isn't surprising (or abnormal) that you would feel that way but that yes there is hope for getting better)

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alexandra_k said:
But having a therapist as someone who gives you care and attention and who has confidence and faith in you should help you too. You get to see him caring for you and as you start to internalise that...

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But the weird thing about that is then I wonder . . . of course I think. . . he's nice to me because I'm paying him to be nice.

And then there's that part I talked about in another post that I have such a strong attachment to him that sort of weirds me out and almost makes me feel guilty. I'm completely happy with my hubby and so it's not a sexual thing I don't think. . . but it's like I am dying to visit with him again. Yeah, having someone to sit there and listen in on my every word and have really helpful nice and kind things to say. . . it's almost addicting. But it's not like something I think I'll ever get in the "real world." Even with my hubby who is sweet to me, I never know how he'll react to stuff because he has his own problems too.

Does having the counselor affirming you really help? I thought the point of the counseling was to teach you how to get that affirmation out there in the real world or at least look for the right people.

But it does make sense that it feels good to get that from the counselor too.

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alexandra_k said:
ugh. sorry about that
(me me me)
glad you are feeling better
(hope i didn't just wreck that)

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You didn't wreck anything! We're just sharing experienced here right? I still say thanks you helped a LOT!

And you were right on about the childhood thing, believe me. I could go into detail but I need to get into bed. I wasn't necessarily high on the list of priorities at times, that's for sure.

The strong feelings of attachment are supposed to be based in transference.

When we are little we are nurtured in a way that we aren't nurtured in any real world relationship later in life... I mean... Think of how mothers nurture infants... they listen to anything the infant wants to babble about... they mirror their feelings (of excitement or happiness or whatever). They pick them up and cuddle them and soothe them and help distract them from the bad feelings...

Then we internalise that so that we have this self confident and happy self image and base conception of ourself and our world...

And then we can engage in reciprocal adult relationships where there is a bit of that (wow fascinating day at the office dear) but that each does it for the other and there is a give and take.

But sometimes when you don't get the infant (one sided) version then ones NEEDS for security and the like werne't really met and without that secure inner representation (and corresponding abililty to self soothe etc etc) we can sometimes be a bit demanding and unable to give as much as we would if we had that inner representation.

If both partners in a reciprocal relationship just want to be nurtured by the other (and neither has anything left to do the nurturing) then things can turn bad.

Therapy could give you some of that nurturing so you develop a secure representation so that you are in a better position to give and take appropriately in your real world relationships outside therapy.

So therapy isn't at all a replacement for reciprocal relationships (therapy is one sided and it is the two way relationships that are meant to be ultimately most satisfying)... But it is meant to help you achieve them better.

Make sense?

But your relationship with your t is different to any other relationship you have and will have outside therapy... And therapy relationships are most similar to... parent infant relationships.

Of course different peoples therapy runs differently... And I guess different therapists have different conceptions of what they are doing. Some would cringe from my characterisation of it... But I would think that your longing for your t is a lot like how you would have longed for your parents to pay you adequate attention... And he DOES listen where they probably did not etc.

So in a way I guess therapy is different from those other relationships. But like you were saying, you love your husband a whole bunch (your t isn't a replacement for your husband AT ALL). But... Because you have a more equal relationship with your husband and your husband has his own issues your relationship with your husband is give and take. Your relationship with your t is where you can be nurtured in a way your husband can't nurture you (without hurting your relationship) but ultimately... It should lead to your having a better more satisfying richer relationship with your husband.

I think...

I think that is how it is supposed to go.

When ever - I - asked one of - MY - therapists what - MY -diagnosis was - I - was always told they as therapists could not officially diagnose - ME -. They can make "guesses" based on what I tell them about me as to what they think - I - may have. but they cannot officially diagnose - ME -.

for an official diagnosis - I - had to see a psychiatrist and or psychologist and take a test called a Comprehensive Psychological Evaluation (Minnasota Multiphasic Personality Inventory and other tests like it) that will tell the psychiatrist, psychologist and - I - what my official diagnosis is.

Getting official diagnosis isn't necessary but is very helpful in getting the correct treatment plans the first time around.

Thanks. I just need to relax and go with what comes up and stop worrying about it.

I've been extremely obsessive this weekend on two things. . . what is my diagnosis, and is my fondness I feel for my counselor appropriate.

I don't know how to get out of the loop my head is in but hopefully it will get better once my hubby gets home.