diagnosis and the prospects of change

metrovelvet

A question for the therapists.

I like to think people can change. I carry an assumption that therapy and counselling help people negotiate through these changes even if it means a supervised breakdown of sorts.

I have a question about your perspectives on how this relates to diagnosis. Is there a danger that certain diagnosis like NPD or even aspergers for example can trap people into destinies?

Odysseus

metrovelvet wrote: »

A question for the therapists.

I like to think people can change. I carry an assumption that therapy and counselling help people negotiate through these changes even if it means a supervised breakdown of sorts.

I have a question about your perspectives on how this relates to diagnosis. Is there a danger that certain diagnosis like NPD or even aspergers for example can trap people into destinies?

You are certainly coming up with some interesting questions Metrovelvet, can your elaborate on you understanding of traping people into a certain destiny? Do you me a person takes on board the diagnosis and may take on its negatives and turn it into a self fulfilling propercy?

metrovelvet

Odysseus wrote: »

You are certainly coming up with some interesting questions Metrovelvet, can your elaborate on you understanding of traping people into a certain destiny? Do you me a person takes on board the diagnosis and may take on its negatives and turn it into a self fulfilling propercy?

Yes, something like that. I'll try to explain but it's a subtle and complicated question.

If someone has a diagnosis, like NPD, and believes themselves to be essentially of this paradigm and perceives what they do and how they think and feel, through the prism of this diagnosis, can it inhibit or even arrest change and possibility, in life, profession, relationship, family, whatever?

It is my understanding that some personality disorders, syndromes, etc are considered unchangeable by the therapeutic professions? Is that right? So if the general public or families or the client himself believes that, can s/he then be stuck in that paradigm/diagnosis?

Odysseus

metrovelvet wrote: »

Yes, something like that. I'll try to explain but it's a subtle and complicated question.

If someone has a diagnosis, like NPD, and believes themselves to be essentially of this paradigm and perceives what they do and how they think and feel, through the prism of this diagnosis, can it inhibit or even arrest change and possibility, in life, profession, relationship, family, whatever?

It is my understanding that some personality disorders, syndromes, etc are considered unchangeable by the therapeutic professions? Is that right? So if the general public or families or the client himself believes that, can s/he then be stuck in that paradigm/diagnosis?

Very quickly, I’m just about to see a client. In psychoanalysis we develop a preliminary diagnosis that is open to change until the end. Diagnosis really is only of use guiding the therapy, you work differently with a psychotic that a neurotic.

My understanding is that personality disorders are the waste bin of diagnosis; difficult diagnoses are caught by the group of PDs. Yes a lot of psychiatrists view them as not treatable to varying degrees. However, one of the psychologists may give you a more researched based answer. However, I have seen people written off as being a PD at clinical meeting.

The whole group is difficult look at the overlap between dissocial personality disorder and addiction. I get back to you later....

Kooli

metrovelvet wrote: »

Yes, something like that. I'll try to explain but it's a subtle and complicated question.

If someone has a diagnosis, like NPD, and believes themselves to be essentially of this paradigm and perceives what they do and how they think and feel, through the prism of this diagnosis, can it inhibit or even arrest change and possibility, in life, profession, relationship, family, whatever?

It is my understanding that some personality disorders, syndromes, etc are considered unchangeable by the therapeutic professions? Is that right? So if the general public or families or the client himself believes that, can s/he then be stuck in that paradigm/diagnosis?

I absolutely agree that diagnosis has the potential to lock someone in to a certain 'pathology', or they can start to identify with it too much.

I would always question the value of even mentioning a diagnosis before ever doing so. The only benefit I can see of a diagnosis is that the person can sometimes get relief from the idea that what they are experiencing is a 'thing' that is 'out there' i.e. other people go through similar experiences. But that's it really.

I also think it's important to think about how the diagnosis gets mentioned, and that will depend on your beliefs around it. Like there's a big difference between the message 'You feel the way you do because you have depression' and the message 'You have depression because you feel the way you do'. If you get me. It's a subtle difference but an important one. Basically the distinction between seeing a diagnosis as a description of symptoms or as an explanation of symptoms.

Odysseus

Kooli wrote: »

I absolutely agree that diagnosis has the potential to lock someone in to a certain 'pathology', or they can start to identify with it too much.

I would always question the value of even mentioning a diagnosis before ever doing so. The only benefit I can see of a diagnosis is that the person can sometimes get relief from the idea that what they are experiencing is a 'thing' that is 'out there' i.e. other people go through similar experiences. But that's it really.

I also think it's important to think about how the diagnosis gets mentioned, and that will depend on your beliefs around it. Like there's a big difference between the message 'You feel the way you do because you have depression' and the message 'You have depression because you feel the way you do'. If you get me. It's a subtle difference but an important one. Basically the distinction between seeing a diagnosis as a description of symptoms or as an explanation of symptoms.

On your first point Kooli, even look at the concept or addiction and recovery, my name is Odysseus and I'm a ... Even when used in the confines of recovery, my name is Odysseus and I'm a recovering...

People replace one ideal that of an addict with another being in recovery. Now whilst this can have some benefits it also has drawback, just sticking with addiction, Peel [who I don't have a lot of time for] makes the point of teenagers in the States being diagnosed as addicts and therefore regardless of the drug used, there are told they must abstain from all chemicals including alcohol for the rest of their days. Peels examples are mostly kids whose parents found a joint in their room.

Within psychoanalysis we would not mention the diagnosis to the patient, for reasons similar to the ones you mentioned, people identify with the diagnosis and start to develop symptoms that are connected to the disorder but which the had not experienced prior.

metrovelvet

Ok so addiction might be one example. My father who was a recovered alcoholic and went to AA, where the mantra was 'once an alcoholic always an alcoholic' refused alcohol in his last weeks of his life. Didnt want whiskey, baileys, nothing. And he knew he was going to die. But he would have liked some guiness, and he wasn't even a Guinness drinker when he was an active alcoholic. So that right there got me thinking about that taken for granted saying that is in AA.

And then there are things like APD and NPD. Can people get stuck in those? Are they unchangeable?

My friend knows a girl who was diagnosed aspergers. And he thinks the girl is trapped by her parents in the diagnosis because they treat her like a lost cause and the diagnosis has become a destiny.

Odysseus

metrovelvet wrote: »

Ok so addiction might be one example. My father who was a recovered alcoholic and went to AA, where the mantra was 'once an alcoholic always an alcoholic' refused alcohol in his last weeks of his life. Didnt want whiskey, baileys, nothing. And he knew he was going to die. But he would have liked some guiness, and he wasn't even a Guinness drinker when he was an active alcoholic. So that right there got me thinking about that taken for granted saying that is in AA.

And then there are things like APD and NPD. Can people get stuck in those? Are they unchangeable?

My friend knows a girl who was diagnosed aspergers. And he thinks the girl is trapped by her parents in the diagnosis because they treat her like a lost cause and the diagnosis has become a destiny.

I have no experience around aspergers, not even academic so I really can't comment on that one. Even with diagnoses that will never change, say a psychosis I have experience there.

With psychoses the person will have that disorder for the rest of their life. However, I do believe that people can have some control in certain cases, leaving the medical side aside; talking therapies can help people re-originate their lives. I have seen people talk their way through a psychotic episode, now of course there were medical interventions occurring concurrently, but they are outside of my brief. Though in some cases medication compliance can be part of therapy.

Giving people the opportunity to put words on their delusions and hallucinations can be of significant benefit. No I want to be careful here, no psychotherapy will cure a psychosis, but some people will live quite a functional [forgive the pun] live. Others may see their live as a lost case, and as you pointed out significant others in their lives may also do the same.

So yes I think some disorders will always be there, and some may always be in the background, however, within limits the effect they have on the person can be changed. A good friend of my used to only work with psychotic patients, a good example she gave me is one person used to give the voices a certain amount of time each evening. That's not to say they were not active during the day, but he allowed them set time to be free if you will allow such a loose expression. So that is a good example of a person taking some control.

A screening question I would use myself is to ask what it is like when the person is unwell, if they used that word. So I would never really see anyone as a lost cause, there is generally something that can be done. It won't mean the person no longer has the disorder, but the effect it has on quality of life may be addressed to some level.

Kooli

Odysseus wrote: »

On your first point Kooli, even look at the concept or addiction and recovery, my name is Odysseus and I'm a ... Even when used in the confines of recovery, my name is Odysseus and I'm a recovering...

Don't get me started on the twelve steps model!! It's definitely the most extreme example of people identifying with their problems and using them to define themselves.

But to be honest, I imagine very few psychologists or psychotherapists I know would subscribe to the disease model of addiction as strictly as that.