Should therapist diagnose patient's absent family members?

**Posts:** 49 · by **sunrisewatcher** » Sun Oct 08, 2017 12:15 pm

Hi all,

I moved cities, so I decided to find a new therapist.

One difference between them has made me feel confused. I'd like to hear what other therapists think about it.

Therapist #1 refused to diagnose (she would say "label") me or the family members I described. I would say "Is my mother narcissitic?", "Am I narcissitic?", "I read about Histrionic Personality Disorder and it sounds just like my mum." etc etc. Therapist #1 would reply, "Labels are distracting and damaging. Let's look at real events, and find healthier ways to respond to situations in future."

In the end I accepted and respected Therapist#1's approach.

Fast-forward to 7 years later, in a new city, and I've started seeing Therapist#2. Therapist#2 loves labels; she throws them out every which way. It seems like the more labels, the better. Having spoken to me about my life for about 40 minutes, she says to me "Your parents are love addicted; your parents are co-dependent".

And, she uses lots of hand gestures while she's making these diagnoses.

She doesn't check in with me to make sure we agree on the meanings of these labels. She just assumes I am able to read her mind.

When I calmly asked for reasons that she used those particular words, she immediately looked down at her notes and read aloud from her own notes from our session. I couldn't see the link between her words and the diagnoses.

I sensed that I would be "letting her down" if I asked any more questions, and I let it go. (incidentially, prioritising other people's needs over my own is a common, dysfunctional behaviour pattern for codependents!).

But let's not get off-topic.

Should therapists diagnose their patients' family members (whom they've never met)?

Are labels (diagnoses) helpful? Or... limiting and destructive?

What do all the practitioners out there think? Thank you.

**Posts:** 12131 · by **Richard@DecisionSkills** » Sun Oct 08, 2017 3:08 pm

No, a therapist should not diagnose someone they have never met. BUT....
.... there is nothing wrong with a therapist saying, "Based on what you told me, possibly...."

It is reasonable during a conversation to draw potential inferences, but it should not be phrased as a statement of fact, but a possibility.

What I'm curious about, and of course there is no obligation to answer...why do you believe someone needs a therapist for 7 years? As I said, I'm curious. My thought process is that a person goes to a doctor for a cure, right? Obviously there are rare exceptions, where a person needs lifelong treatment, e.g. dialysis.

**Posts:** 49 · by **sunrisewatcher** » Sun Oct 08, 2017 9:32 pm

Hi Richard,

I went for 4 sessions in 2010 (focussed CBT).
3 sessions spread over the following 5 years. These were in response to help coping with specific events. In 2012 my paternal grandfather died and this set my father off on a drunken rage that I got caught in the crosshairs of. In 2013 an ex committed suicide, three months after I ended our relationship

More recently I have been trying to face the music & DEAL with things. I met one time each with 2 psychologists who I didn't warm to.
And I've had 2 sessions now with "Therapist#2".

So what's that? 11 sessions over 7 years.

I like "having a therapist". It makes me feel safe. The therapist will be there if I feel I want to make an appointment.

I don't have the time/money/patience to go every week.

The real work & change happens "off the couch", anyway. Therapist just guides, reflects, offers insight.

**Posts:** 12131 · by **Richard@DecisionSkills** » Sun Oct 08, 2017 11:15 pm

sunrisewatcher wrote: I like "having a therapist". It makes me feel safe.

Thanks for the response.

I don't know the significance of a certain number of sessions over/years. I simply find the evolution of therapy fascinating, the profession of "therapist" and how it has transformed over time, hence my curiosity. The safety aspect is interesting and it seems to fall inline with other sociocultural developments that have evolved to provide people with a sense of comfort or safety.

Thanks again.

**Posts:** 49 · by **sunrisewatcher** » Sun Oct 08, 2017 11:40 pm

In the old days, people "felt safe" because they had religion, patriotism, clear gender roles, and a strong identification with family (possibly living with extended family multiple generations).

The substitutes people use today are "brunch with the pals", shopping / debt, Facebook & Instagram, internet dating, therapy, yoga, CrossFit, involvement with large international charities, etc.

If you're interested in the future, chatbots for therapy are interesting. I've heard from the lips of a top psychiatry academic (but never investigated it) that studies rank effectiveness as follows:
1) Online (automated) CBT programs - most effective in curing depression.
2) Face to face talking - second most effective.
3) Pills - third most effective.

Cheers

**Posts:** 49 · by **sunrisewatcher** » Sun Oct 08, 2017 11:41 pm

Oh, and some blokes today also love their online gaming in a live community. I forgot to mention that one!

**Posts:** 49 · by **sunrisewatcher** » Thu Nov 09, 2017 5:49 am

Have figured out the answer to my orginal question.

Therapist#1 should have listened to me in 2010 when I raised the questions of narcissism & histrionic personality disorder in my family of origin.

Because she so totally disregarded my suggestions, and because I considered her the "expert", I ignored my own feelings and ideas... and in doing so, missed out on 7 years of healing.

the lesson here is:
Consider the views of authority and "experts" but don't distrust your own observatiobs. Therapists can be flat-out wrong.
Trust the still quiet voice within.

xox

Should therapist diagnose patient's absent family members?

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