The most common way therapists pathologize is to categorise symptoms, feelings and behaviours in order to offer an appropriate treatment.
Diagnosis in the UK
Typically in the UK, only medical doctors and clinical psychologists are qualified to provide formal diagnosis (this obviously includes psychiatrists, who are medical doctors). This means that counsellors and psychotherapist cannot give formal diagnosis. In the IAPT systems, whenever a CBT course is offered, the therapist needs to create a ‘formulation’, which can sound very similar to a diagnosis, but it isn't. This methodology allows the practitioner to follow an appropriate and streamlined course of action.
Diagnosis and depathologising
Formulating and treatment planning is effectively used throughout the NHS. Yet, there are other ways to think about therapy. It is a common misconception that all therapists are concerned with diagnosis. A large current of therapists uses the term ‘depathologizing’. This is not necessarily opposite to diagnosing; it just describes a different process. (Therapists who are more attentive to depathologizing usually belong to Humanistic or Existential schools.)
Depathologizing does not mean to be naive about the distress or downplaying it. It indicates the process of 'tuning-in' with the human being behind the diagnosis. This transforming process allows the client to feel more human and normalised.
It is important to distinguish between diagnosing and depathologizing.
How can a diagnosis be helpful?
A diagnosis can help people feeling more in charge of their own mental health and, as a consequence, more proactive towards self-care. For example, thinking about depression or anxiety as pathologies can help reduce the stigma. ‘You name it, you own it’.
A diagnosis can also give a sense of empowerment. The person finally feels heard and recognised in their psychological distress by a professional.
Ultimately, a diagnosis can give access to specific medical treatment and financial support. Often the person needs to have a formal recognition before they can access a certain type of aid.
How can a diagnosis be unhelpful?
When a person gets diagnosed, they can feel trapped in their mental illness. So the diagnosis easily becomes like a curse. In this case the person finds it difficult to shake it off and they feel trapped in their diagnosis.
The diagnosis focuses all the attention to the difficulty that the person is experiencing, with the risk that they will identify with their pathology. So the individual ends up reducing their identity to just an aspect of themselves, which is unfortunately reductionist. For example, even in the case of severe depression, there is more to a person than their lack of energy and feeling of lethargy. The therapist could also help the client to recognise their strengths and resources.
Soothing the therapist’s anxiety
More often than not it’s the inexperienced therapists who are more concerned with pathologiszing. This is to soothe their own anxieties. In this case the diagnosis will serve the interest of the therapist and not the client’s (which is not just unhelpful but also unethical, according to different codes of ethics, the BACP and the UKCP for instance).
The process of depathologizing
At the end of the day, the scope of diagnosing is just semantics unless it promotes empowerment. Diagnosing needs to be functional to something, for example accessing services and therapies.
Depathologizing is the process of leaving behind whatever symptom brought the client to therapy, and meet the individual in their whole identity. This is a process that can allow us to move away from shame and the thought that there is ‘something wrong with me’. Depathologizing is also an internal process to free ourselves from internalised shame and stigma.