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If you tell your therapist that you want to be fully informed, it is unethical of them to refuse to answer your questions fully.
You may need to spell it out for them and tell them if they are not able to have a therapy relationship that has mutual respect for needs then you will need to find a more compatible arrangement.
They are not the boss of you, they are providing you a service. That is why you have to pay them. If they refuse to provide the exact service you need (and you do need it or it wouldn't bother you). Then find one who is willing. Someone more like-minded and equal.
Some with analytical minds do gain relief from information that offers knowledge and learning. It's not a flaw.
My therapist and psychiatrist are both very open about disgnosing me with PTSD and Major Depressive Disorder. For them, I think it's largely a thing to put on their paperwork which is required by the state and country. It does help to know exactly what I have, since I didn't for a few painful years before I was diagnosed, but the really important thing is to go from there. Work out your traumas in therapy, get meds if you need them, and keep working out your traumas in therapy. I thought I'd worked all mine out, but it turns out I really haven't. Just saw my T today and we talked about a whole new trauma that I hadn't even identified until recently. So it's going to be tough going for awhile, but worth it, as I know from past experience.
Are you private pay or do you go through insurance? If you go through insurance, they have to provide the insurance company with a diagnosis for billing purposes.
This is one of the topics I find infuriating about the mental health field. I worked in the "physical" side of the medical field for over 30 years so find it convoluted that there are such variations in practice. Yes all patients, regardless if they are seeking medical or mental health services, have the right to fully participate in their care. The core principle that underlies this is informed consent. Broadly defined, this means patients should be provided information about their condition and prognosis, and the treatments and therapies that are indicated for their condition, including the risks and benefits of each before treatment is initiated.
All professions complete assessments and use this information to derive a working list of possible conditions or diagnoses. Regional and professional standards define which professions can determine medical or mental health diagnoses, but all professions create some type of condition or problem list. Once the diagnoses and/or conditions are defined, the mental health professional collaborates with the patient in determining treatment goals and plans.
I scanned a number of professional standards to verify this holds true in the mental health field and found that ethical standards are pretty similar across the board. I did find national practice standards for the Australian mental health workforce at health,gov.au that you may find informative.
This is a topic that warrants further discussion with your psychologist. While your welfare is of course his concern, his reluctance to share this information sounds almost paternalistic. More concerning is the fact that it is indeed unethical not to share his diagnosis of your condition. After all, it is your diagnosis. There are of course occasions when a diagnoses has not yet been fully determined. In these situations the therapist should provide information about the diagnoses he is considering, the assessment tools he is relying on to provide this information, and any other pertinent information used in determining the diagnosis and fomulating his proposed treatment plan.
It infuriates me too. I have been through this with a clinical psychologist. It was a nightmare. I put up with it for 2 years. I felt completely lost in the dark the entire time. It felt horrible not knowing or having answers/information, especially while suffering so many symptoms at the time too. For me, not having a clear diagnosis kept me stuck.
You can ask to be referred to someone for a second opinion and to have a full comprehensive assessment. You are absolutely entitled to a second opinion. In both the APS and ACPA Code of Ethics that clinical psychologists are supposed to abide by, it states, "Clinical psychologists should help patients secure second opinions" and "To benefit, enhance and promote the interests of clients, and subject to standard A.5. (Confidentiality), psychologists offer practical assistance to clients who would like a second opinion."
Furthermore, you can organize it on your own independent of your clinical psychologist. I saw a psychiatrist for diagnostic clarification, he assessed me for everything, and diagnosed moderate-severe PTSD using the CAPS assessment tool which is regarded the gold standard in PTSD assessment.
I thought my desire for a diagnosis (or alternatively knowing there is none) was one of my "quirks" and I've been trying to be okay with it for a year now.
I don't know why it's so important to me. Initially the fear of not being welcome here was a major part of it, but I've been here long enough to know that I will be welcome regardless.
Any thoughts on how to stand up for myself on this issue with my T. This is the type of thing I need help with ... wanting something but not knowing how to ask for it (one of my many quirks).
Really great replies here, thank you so much everyone.
@Fadeaway - I'm in Sydney, and seeing the T privately, so there's nothing mandating him to assign a diagnosis. So a bit different from the U.S.
@Flossy and @SabrinaB - I really appreciate your feedback. Yeah, it does seem quite paternalistic doesn't it...I've tried discussing this with him on a number of occasions and he just doesn't budge. Don't get me wrong, I don't doubt he's genuinely trying to do the right thing. But it does leave me very confused on, well, dude, what are you treating me for if you won't tell me what's "wrong" to begin with??
I'll try the "informed consent" argument in my next meeting, will try to be careful not to come across as unduly aggressive though.
@Summer Ava - ironically, this guy is my "second opinion"...the first t I spoke to gave me some really upsetting/distressing feedback saying that I had been abused as a child...which was really devastating, and I had such issues accepting her assessment that I went to the current/new t to get an independent view - and he basically won't. I've posted on this forum previously in my likely lame attempts to figure out if my family was really so abnormal that it crossed that line - I've pretty much given up on answering that question now...but still - what is wrong with me?
Do I just have depression? If so, why? Is this all stemming from "traumatic" events? If yes, how far do you really stretch that concept? Am I actually "ill", or something else? Or is it more just about the way I think and view things?
maybe him telling me what "it" is will upset me...but I'm upset anyway (!!). The current situation I'm just sat here thinking I could be literally "mad" or I could just be some malingering muppet...
oh, and @Flossy - re: analytical minds...this is one of the things we mainly discuss - and to be fair I think he may be onto something...
- I get upset because something happens;
- I shut down the feelings and emotions;
- Retreat into my head, and intellectualise everything;
- My analytical side starts assessing what happened to find the mistakes that I made that purportedly "caused" this event.
We have repeated conversations where, I describe events as if I'm discussing my shopping list; or debating the facts/circumstances of the "thing" rather than doing what I'm supposed to do...which I imagine...is being upset??
I think his point is that my "analysis" is usually a front that prevents "feeling"...or something...I still find this confusing.
Depression isn't a 'just', it's it's own hell in it's own right. Why? Generally there is something in the brain that's not firing right - and it could be genetic, late-onset, it could be developed over time due to environmental (situational) factors, some combination of the two...no-one knows the exact 'why' of depression. It's more relevant to deal with educating yourself about the disease, accepting that you have it, and finding ways to treat it - medication, cognitive therapy, maintaining overall good health.
The only 'why' that is pretty well known is that depression can be the result of an injury to the brain (Traumatic Brain Injury, or TBI). But if you've eliminated that as a possibility, then you're left with the stuff, above.
The brain - it's neurology - is most vulnerable in the developing years, because one is literally learning how to think. All the input the brain is given - the experiences, the shocks, the joys, the fears - creates the foundation for the brain you will have for the rest of your life. So, yeah - whether you are diagnosed with PTSD or not, the things that happen to us - good, bad, ugly, awesome - shape who we are, neurologically. How we think. Even a person who grew up being smacked every time they broke a house rule - would we call that 'traumatic'? Sure. Because even if what happened is your mind accepted it and got used to it and it became the norm (this is also what brains do, they adapt to the situation) - the first time it happened, it wasn't normal. The first time it happened, it was frightening and painful - and possibly even more than you might think.
Ever see a baby taste a lemon for the first time? It's incredibly intense. Eventually, we get used to what 'sour' feels like on the tongue - but the first time isn't normal. It's shocking. Now, as an adult, you can't remember that - and you've adjusted to the spectrum of tastes, and nothing is as intense anymore. Replace 'lemon' with 'abuse'. Not much is different, except we are physically meant to learn how to taste sour - we have taste buds meant for it. We don't have any receptors that are meant for getting used to being beaten, or raped. It's called abuse because it is AB-use. To use wrongly. People adjust. But it doesn't mean there aren't emotional consequences, brain consequences.
Honestly, pretty far - see above. Whether it becomes PTSD or not - everything we learn about how to be in the world, how to think, how to interact - has a foundation in childhood. And the painful things sometimes generate a kind of mental scar tissue. If the scar tissue is causing you distress in your adult life, then you deal with it, to hopefully alleviate your current pain/distress/sadness/anger/whatever. This is why there is a thing called therapy.
It doesn't really matter, to be honest. There is no absolute scale here. It's not a virus. The body doesn't fight it on its own, because it's a higher organ (brain), you need to deal with it purposefully. Does that make you 'ill'? Personally, I'd say yes - but what's wrong with calling it illness? You have an illness, you deal with it as best you can. Or, it's like ageing - the wear and tear of life eventually causes us to use our bodies differently. We have to treat them differently. The wear and tear on the brain, as a result of life, is a real enough thing.
It's everything to do with the way you think and view things - but that doesn't make it an insignificant thing, or a thing you can make right on your own.
There's a really big spectrum in-between those two things. But I think there is a really big clue in your choice of phrase - 'malingering muppet'. I'm going to say something that I absolutely hate hearing myself, it makes me squick and squirm...But here it is: If someone you care about was sad, and struggling, and didn't know why - would you call them a malingering muppet? Probably not. You'd probably want them to feel better, and help in whatever way you knew. So what makes you treat yourself differently? Can't you, instead, treat yourself the same way you would treat someone you care about?
Here's the thing. My therapist tells me I was neglected by my parents. Now, that's not my capital-T trauma. It has a decent amount to do with where my depression comes from, probably. Anyway, he tells me this, and while I can see how he would say that, it doesn't feel like that's the right word for it. I was the first child. My mother was dealing with managing my father, who dealt with his own mental illness. And I was smart. My parents knew nothing of how to parent. So they started telling me to make my own decisions about things when I was 5, 6 years old. Like, when I sat so close to the TV it was clear I had eyesight trouble, my mother asked me if I wanted to go to the eye doctor. Asked. I said no. About a year later, when I was getting headaches, I changed my mind and said I'd like to go to the eye doctor. Sounds like the dumbest, littlest thing in the world - pales in comparison to what other people went through as kids. But the first time I was asked to decide for myself (it was before the glasses), I was so afraid for the whole time I was trying to decide, six or seven months, and I remember that fear viscerally. Glasses, I was afraid too. But by the time I was 10, 11 - it was just normal. And I knew it made me sad. But I assumed that 'sad' was just what I was. And I tried to kill myself when I was 10. Because I didn't think I belonged anywhere. I failed. They never knew. And I remember that failure.
For me: it was my fault they didn't parent me. It was my fault I failed. Really, it was my fault. I'm at the point where rationally, I can see how it wasn't my fault...but there's this bizarre gap between knowing that and believing it. Most of the time I'm not totally aware of how that lives inside me and influences the majority of my thoughts about myself. I'm learning how to notice, and change those thoughts.
And my therapist tells me I need to go through 're-parenting' - that I need to learn to give myself the love, boundaries, forgiveness, positive reinforcement, that I was not given by my actual parents. When he says that, I tell him to shut the f*ck up - it makes me that uncomfortable. It sounds so awkward, so strange, so broken - I cannot imagine doing it. Except, do I really want to hate myself for the rest of my life? Well, no. So I'm gonna have to walk through all that stuff. And none of it is PTSD. Diagnostically, it started as one form of depression and moved to another. I was happy to know there was a word for it. But the word doesn't change the fact of it, or make it easier, or make it harder.
I'm a thinker too - and I had to get really, really upset before I finally ended up getting help, being open to looking at these things, starting to grasp the connections, trying to learn to change the way I think. So you might be at the point where you are upset enough to actually start to work on it. The 'why' of it is really, not about the diagnosis, so much as it is about the puzzle of experiences that shaped how you think, and how you continue to shape your thoughts.
I walked out on my first therapy appointment, too. It was a little over 20 years ago. I filled out some sheets, answered some questions, and the person told me I was so seriously depressed that I needed immediate medical intervention, and they suggested an inpatient stay of two weeks to start. I walked right out the door and never set foot in a therapists' office again til 6 or so years ago, now. By then, I was ready to maybe possibly start to try and deal with it. And really - some part of me knew I was depressed, must have - but at the time, that word, being told that it wasn't on the 'normal' spectrum to think about suicide daily, the word 'inpatient' - I actually wish, looking back, that the person had taken a more oblique approach (for what its worth).
I think if you want to know the diagnostic term for what you are struggling with, in his opinion, it's more than appropriate to say, 'I want to know what you think you are treating me for, right now'. It might be helpful for you at this point. And regardless, I think if you are asking, you deserve to be told.
Just remember, it doesn't always explain everything. It's more information, nothing more or less. It's his opinion based on what he knows of your symptoms, now. And it's going to be a catch-all word for the impact of the sum of your experiences. Mental health isn't as pinpointed as any of us would like, I think.
Thanks for tolerating my speechifying. There have been things about your story that resonate with me, and this seems to be the post where all my thoughts came out at once. Take what's useful, leave the rest.
I have a bag full of diagnoses. I'm on disability and my therapist that gave me all those dx told me it helps me keep my benefits. I disagree that I have BPD as does my current therapist who is a trauma expert. Anyway, I read a lot of books written for therapists and it helps me identify with certain areas of dysfunction. That's what is most helpful for me, relating and identifying. As for what I do with the info I read, I write questions to bring to my therapist, I ask questions on this forum, I talk to my friends, it all helps me make sense of a very chaotic constellation of symptoms that all boil down to the after affects of childhood sexual abuse and violent assaults as an adult, and being poisoned at work. It's a full bag, but I don't have to unpack it all at once.
