I saw a client for a diagnostic assessment. Both parents were actively involved with the assessment and were genuinely concerned about getting the best help possible. The mother of the client was extremely prepared: wrote down notes that she wanted me to know, took online tests and provided me with the copies, and brought a whole bunch of questions for me to answer. I love it when parents are this involved because they show that they care about the mental health of their child.
The client was very cooperative and displayed some of the symptoms the parents were explaining to me. There have been medical problems since birth that have been misdiagnosed which the client is still overcoming. Medical test after medical test was completed and no definite answer for the abnormal behavior, at least biologically. After obtaining a through history and probing into symptoms and the triggers that accompany those symptoms, I came to a conclusion that I need more information.
It is so easy to see clear cut symptoms that correspond to the underlying criteria of a specific disorder. When all you clinically see is symptoms that fall within a spectrum of disorders or conditions, then properly diagnosing a client takes more time than is allowed by most insurance companies for reimbursement. I am supposed to gain enough information to give and support a diagnosis after the first time I ever see the client. Most counselors can understand the uncertainty of that issue when there just does not seem to be a correct diagnosis.
As insurance companies are watching every penny for reimbursement purposes, they are less likely to comply with any diagnosis that requires further investigation. The billing department at my agency received multiple claims back from insurance companies over last few months because they will not pay for any NOS diagnoses. In unclear circumstances an NOS diagnosis may be most applicable until further sessions supply enough supporting evidence for a stronger diagnosis.
What are we to do when so much information is available but so little applies or is accepted in murky situations? Parents with children who are going through discomforting behavior just want a clear and understandable mode of offense. When the ability to give that mode of offense is limited for supportive criteria reasons or financial reimbursement reasons, it feels like the system is failing them. As counselors we have the training to bring some order to chaos through equipping our clients with the best knowledge and practice with their specific issues.
I hope as the DSM-5 goes through its final stages of research and write up that some form of order will come to the area of diagnosis. I’m not sure based upon what I have read in the proposals that we will arrive at the golden standard in this new edition, but I hope it is a step in the right direction. Only time will tell what the DSM-5 will bring us but until then, my fellow counselors, keep assessing, diagnosing, and treating to the best of your ability. We will arrive but it may not be in the near future.
Josh Andrews is a counselor at a behavioral health agency working with children, adolescents, and families. His professional interests include the spiritual side of humankind, cognitive behavior therapy, reality therapy, and advancing the knowledge and practice of professional counseling.