Why we (rarely) Diagnose

Mental Health Diagnosis

We live in an age where the medical profession likes to pathologize. Much of the medical model is about diagnosis and drugs. I believe a lot of that pressure comes from insurance companies. In general, to be reimbursed through insurance, you have to have a diagnosis. In theory, mental health care is supposed to be as preventative as it is reactive. How does one get preventative mental health care if they can only do so with a diagnosed mental health disorder? Some would argue that diagnosis helps with treatment planning. I do not entirely disagree. Many people have similar symptoms and having a diagnosis can help find interventions that have been shown effective. At the same time, a counselor can keep a mental note of a diagnosis and use that as opposed to making it part of someone’s permanent health record.

Having a diagnosis on your record could not be a big deal at all. If you are dealing with something common like anxiety, it may not be a concern. On the other hand, diagnoses could impact one’s ability to get into medical school or the military if they so choose, just as a couple of examples. A diagnosis could impact life insurance rates or cause an insurance denial. With a specialty in couples counseling, there is even less reason to diagnose. If a formal diagnosis is not going to add value and provides a potential for harm, counselors may ethically refrain from making a formal diagnosis. Relationship difficulties (as we specialize in) are not considered a medical problem, hence those who do take insurance often cannot apply it to relationship counseling anyway.

It is for the reasons stated above and others that we do not take in-network insurance. Not using insurance avoids the pressure to make a diagnosis and put a unique person into a box. Not using insurance helps individualize care. Not using insurance helps the treatment to adapt as your needs change as opposed to creating a premature treatment plan to please insurance companies that could carry pressure to get you out of counseling sooner than you are ready. I believe a counselor’s job is to see the best in every client. Saying “I have a borderline personality client this afternoon” is different than saying “I am seeing Joe this afternoon, he has unmet needs and trauma that cause him to want attachment but to push it away because of fear.” I prefer the latter.

The reason “rarely” is in parenthesis in the title is because there are exceptions. You may want to bill insurance out-of-network and have a legitimate diagnosis that you prefer to go on your record to get reimbursement (although, as stated, this is not likely to be covered for couples therapy). You may want a diagnosis for disability benefits, but that is unlikely to come up in our marriage counseling sessions. You may want a diagnosis so if your health records move on to another provider, they understand your conditions. But, as mentioned, diagnosis is much less likely when dealing with couples, as the primary issue is the relationship. Diagnoses are typically only recorded at Cardinal Point Counseling if you ask for one and it can be legitimately applied.

If you have good insurance that will support couples counseling, it may be a great deal for you, and Cardinal Point Counseling may not make the most sense for you. Just be aware of potential privacy concerns and how some information could potentially be used against you. I also advise clients to make sure they understand their mental health benefits in advance. For many, benefits are good and make mental health care close to free to them (if they can have a condition treated as the main focus of the counseling). For others, there may be a high and separate mental health care deductible. Insurance could sound good on paper until you realize that you need to spend $5k first. There can also be very high co-pays. And if your primary need is marriage counseling or couples counseling, these are likely not to be covered by your policy.