Great article AG! Thanks for sharing. I totally agree. Honestly, I think many of us could flip through the DSM and probably come up with a bunch of different "diagnoses" that fit behavior at any given time, but then I think one could do that with about any human. It is all so subjective and I really don't like it, but it is a necessary evil for insurance.

My T refers to the DSM as a "cookbook" to come up with something to satisfy the insurance company. He has resisted discussing a dx with me even though I have pushed for it. I guess he does not see the need for it as far as how we conduct our therapy.

BG... I just want to say here that it sounds like you have a really good T. Glad for you.

Thanks, AG for the link.

TN

Fascinating article and blog, AG. Thanks for sharing the link!

Glad everyone is finding it interesting! I think a lot of the reason that I was so able to do so much healing with my T is that he helped me see my problems through a lens of arrested development rather than pathology. That shift helped me see a lot of my behaviors as useful when they developed, but now being maladaptive. Changing a learned behavior somehow seemed much more possible than fixing my "brokeness" or "sickness." I'm not sure this would be true for everyone, but it did work for me.

I really loved reading this. As a person who has been diagnosed with BPD, I can fully understand the importance of not allowing a diagnosis define who I am. I have embraced my BPD because out of everything that I have ever read, it's spot on. It's everything that I am, and I understand the fluidity of diagnosis, especially when so many disorders overlap. I've felt like a diagnosis in my case has helped me to understand myself a bit better, but it also has allowed me to realize that I am not defined by the diagnosis and that T doesn't define me by the diagnosis.

Thanks for posting this AG!

--Broken

quote:

My T refers to the DSM as a "cookbook" to come up with something to satisfy the insurance company. He has resisted discussing a dx with me even though I have pushed for it. I guess he does not see the need for it as far as how we conduct our therapy.

My T says she doesn't like diagnosis either, but of course the insurance wants it. Even if my T hadn't told me my diagnosis, it gets printed right on my Explanation of Benefits statements for my therapy so it's not like it's a secret.

AG: My T has explained my issues in that light as well. Most of the time. Every now and then I feel pathologized, but I'm not sure if it's her or me resulting in me feeling like that.

My T resisted diagnosis (well, I wasn't actively asking, but when we have discussed that word, he has emphasized me as an individual, rather than me as existing inside some rigid category) and we still don't actually talk about it directly almost at all. When I asked him questions about CPTSD vs BPD vs DID, he just mentioned that my dissociation is somewhere on a spectrum and regardless of label, we are working with my individual experience of myself and the approach is not dependent upon the label, but those experiences. No matter what the label, I have stuff that got put away somewhere that needs to come out "into the light" as he likes to phrase it, be experienced/integrated/whatever, grieved.

I did find it at least useful to be given an idea of what I'm dealing with, but only because I felt like it gave me "permission" to acknowledge my own reality and share in a way I had been resisting up to that point. Basically, if I don't have outside validation of my experiences, I struggle to trust myself and drive myself crazy constantly interrogating myself. Well, I still do that, but while we have barely discussed the actual diagnosis that we're using (which has become mostly for insurance purposes), we have begun discussing my experiences much more, rather than me discounting and hiding them. So, while I don't think the diagnosis itself is particularly useful, I think the process of discussing, "What the ---- is going on with me?" was very helpful. I don't think those discussions would have happened otherwise.

It kind of scares me to read everything they say about BPD. I accepted the diagnosis a few months ago and I am NOTHING like the people described. I have about five traits but none of them are extreme. I try not to think about the diagnosis - like I said it scares me that someone might judge me. However, I have embraced it and it has helped me deal with how I have acted in the past and feel less horrible about it. In addition, the DBT skills really help me. The greatest benefit has been much better emotional regulation. So, I think it's about how the diagnosis is brought to light. I would hate to think that my T doesn't like and that's why I got the BPD diagnosis instead of PTSD.

quote:

So, while I don't think the diagnosis itself is particularly useful, I think the process of discussing, "What the ---- is going on with me?" was very helpful. I don't think those discussions would have happened otherwise.

I've found the same thing-- diagnostic terminology and criteria do provide a useful springboard and framework for discussions, but it's good to recognize that they are just words used to express experiences and as such are subjectively interpreted and applied. It's not the same as a diagnosis of diptheria or high blood pressure or anemia or something that can be scientifically and medically tested for and proven to exist or not to exist. I think some people lose sight of that fact when they talk about mental illness.

Fire away UV, you're preaching to the choir!

UV,
I just meant I'm not a big fan of diagnoses, so I didn't feel like you were hijacking the thread or going off topic. It's why I posted the link in the first place. My T had a fairly eclectic approach, but definitely had a psychodynamic approach. Frankly, I think he used anything that worked with any particular patient. But he never saw clients as a diagnosis. He would just be with a client and let it unfold and deal with whatever came up. So with people like me who had an insecure attachment and all the fallout of long term childhood trauma, he knew to dig deep and deal with the developmental issues.

Personally, I've always thought of diagnoses as something to keep the insurance company happy. We are not a bundle of symptoms, we're a person. I very much agree with you that from a research/investigation standpoint, you do need categories and classifications, but as always real life is messier than the templates we lay over it.

So yeah, I meant a choir of one. If what I said in any way felt like a criticism, that was totally not my intention.

AG