What is diagnosis and do counsellors diagnose?

There have been discussions in professional circles as to whether a trained counsellor can diagnose mental health issues or not.

Let us start with the questions: “How does the counsellor know what to provide counselling for?

How does the counsellor know that a situation/condition is beyond his/her specialty and that the person should be referred to another person to take it up?

How would the counsellor know who the appropriate person is to take up the case?” All these questions find their answers in the term diagnosis.

Diagnosis

Diagnosis is the ability to accurately tell what a person needs help with. Although some counsellors receive education about diagnosis and the DSM (Diagnostic and Statistical Manual of Mental Disorders) classification system, many shy away from using the term diagnosis.

That is because they either do not know that they do diagnosis, even if they do not term it that way, or they have not been equipped during their training as to how to know precisely what they are providing counselling for.

May I share this experience? Counsellors’ work settings include academic institutions, hospitals and medical centres, prisons, church, schools, job placement centres, crisis response services, community and rehabilitation centres just to mention a few.

During my counsellor training practicum, one of my placement sites was a senior high school. A student was referred to the counselling centre because of a disciplinary measure, but he was not complying with it fully. As a result, he was expelled from a particular subject teacher’s class.

The student was said to have refused to copy notes in class. When the teacher noticed it, he gave him an ultimatum that he either writes in class or bring all the previous notes or he would be out of his class until he does that.

The student seemed to be adamant, and thus, was referred to the school counsellor. When the school counsellor discussed the issue with me, I conceptualised the case and arrived at a preliminary formulation.

This conclusion which helped me to know what I needed to work on is part of the diagnostic process.

This student was experiencing social anxiety. It made it difficult for him to write, especially when others seemed to be looking on or scrutinising him when he was writing.

To make matters worse, his classmates were not willing to lend their notes to him. So, he was not intentionally refusing to write notes. It was actually a very distressing situation for him.

I am convinced counsellors diagnose, even if they do not term it as such, but denying that it is not in their purview will be to deal mental health care a fatal blow.

And counsellor training institutions that do not have this in their curricula should endeavour to take a second look at it because a counsellor who cannot do basic diagnoses will be doing more harm than good.

The writer is a consultant, counselling professional & lecturer.