Assessment and Diagnosis: Is it all about being broken?
Sometimes people are reticent to come to therapy or counseling for the concern with being labeled some kind of __________. Perhaps others have suggested in their attempts at identification of a problem what the flaw may be. It’s very important to understand the difference between symptoms (anxious, depressed, etc) and disorders (Anxiety, Depression, etc), as well as how to address and deal with disorders if they are present.
In the practice of differential diagnosis (sorting out whether something is something), it’s helpful to understand the larger picture of explanation for certain patterns or kinds of thoughts feelings and behaviors (symptoms). A general strategy from theoretical physics can help…
Occam’s razor (also written as Ockham’s razor and in Latin lex parsimoniae, which means ‘law of parsimony’) is a problem-solving principle attributed to William of Ockham (c. 1287–1347), who was an English Franciscan friar and scholastic philosopher and theologian. The principle can be interpreted as
Among competing hypotheses, the one with the fewest assumptions should be selected.
In the identification of disorders there are filters/layers of explanation (probable hypotheses) to work through in finding the potential reason why someone might be doing or feeling a certain way. As disorders are a collection of symptoms, it is important to look at the presenting symptoms and apply these filters.
The first screen for explanation is a general medical condition. For instance, if we consider a presentation with symptoms of: no energy, no appetite, disrupted sleep, poor attention and concentration, low interest in things… one might see a depressive episode, although if we have the flu or a cold emerging, that would be a more appropriate explanation. The 2nd filter is looking at drugs, alcohol or other food or nutrition influences. The 3rd screen would be looking at present stresses or circumstances. If not present events, perhaps there are associations with past experiences (traumas, abuses, tragedies or dramas) we get reminded of and re-experience. Finally, when no other explanation is viable, we would take the symptoms and match them with disorders known in the psychiatric diagnostic manual.
Understanding origins or causations can have tremendous implications to the strategy of solutions. It’s really important to get this part right.
We humans have an amazing ability to automate many tasks, thus we can use our thoughtfulness and willfulness to engage “more significant”, perhaps higher level concerns. Some scientists call this ability with automation our zombie brain. Athletes and others who rely on programmed repetitive motion, something we might also call muscle memory, know that if we train well, we can ask things of our bodies and brains to react in circumstances in a predictable and desirable manner getting positive results, as long as we don’t over think at such times. Actually, in performance (flow) mode, it is better when we don’t think too much and just rely on this flow of programmed or trained action.
Good news and bad news is that we have this ability, whether we have purposefully trained for a specific function or not. Addiction and compulsive behaviors use the same system of unthinking muscle memory to consistently accomplish the ends of those behavior patterns. Good habits and bad habits have consistency in common, but the outcomes differ by good outcomes or bad outcomes.
Ruts are the bad habits and patterns we repeat, getting unwelcome results. Grooves are those habits and patterns we prefer to engage in to get the results we want. The great challenge is how to break out of the ruts and proceed into the grooves. The good news about the bad news is that the amazing way we consistently hit lousy targets (as in addiction or compulsive patterns, bad habits) is the use of good skills to get and maintain bad patterns, consistently getting bad results. So it’s not a complete revamp in changing from ruts to grooves, just refocusing on the desired targets, and clarifying the best strategies.
Using the other amazing abilities we have, willfully thinking, choosing and acting, we can then learn new paths, training good behavior patterns selected to get better results. It isn’t easy, but it’s likely easier than it might seem.
Are we just going to rehash the past? No actually not rehashing. It’s a legitimate concern regarding reviewing past experiences and events (old stories), without doing anything different with them or about them. We cannot change what has already happened. We can change how we see it, think about it, and what we take away from it. The point is to be able to do what we really want to do, with the present, in the present!
All of us use the past to explain the present. We all use the reference of things we have been through when we are experiencing the present. Inasmuch as we are already reliving past things over and over again, we do need to understand what is being played out. Again, the point is to effect change in the present, living, thinking and being our best self right now.
You’ll understand very clearly how our bodies/physiology/neurology use the past, as well as tools, strategies, techniques to utilize so that we can be more present now.
Many people say, “I’ve never done this before, is there anything I need to know?” and my response typically sounds like this…
“Now that you’ve made the call, that is the first step in a process to explore, identify the problem and begin to develop a strategy for the solution and take steps toward that solution.”
Counseling is rather simple at it’s base; conversation which will lead toward greater understanding and clarity leading to select changes or adjustments of thinking, feeling or behaving which are most likely to result in the outcome we desire.
Easy to say, harder to do, I know. That really is the foundation though. An experienced counselor has many theoretical understandings and practical tools to utilize to assist you to identify what you want (goals), identify and understand the things in the way (problems), sort those into the movable and immovable pieces (targets), and map steps to help you get to where you would like to go (objectives). That’s the plan.
Wisdom Counseling offers psychotherapy services for people dealing with depression, anxiety and relationship issues.
Patrick Maloney has specialized training in working with chemical or behavioral addiction issues, trauma or abuse issues, relationship issues and providing spiritually integrated counseling for people of faith.
Coaching, training and consultation services are also available in person or via distance by electronic communication.
I work with many insurance companies, as a contracted provider (Cigna, Aetna, United, Cofinity, Mines & Associates, Magellan, etc) and patients can often utilize this coverage for their care.
My hours are generally Monday through Friday, scheduling appts from as early as 9am to as late as 6pm M-Th, 4pm on Fridays.
Call for an appointment (303) 630-9473