I wonder how a therapist can make a diagnosis from only one meeting, then go further and make a diagnosis from hearsay.
A friend of mine sees a therapist. This therapist has diagnosed him with anxiety, nothing more, from issues regarding the end of a marriage. This therapist carries a PhD. Another therapist, with an MS, has made several damaging diagnoses after only one visit with my friend. This second therapist has made several claims regarding inappropriate sexual behavior through the reports of an ex-wife and the inconsistent report of a 4 year old. From meeting the ex-wife, it is clear she does not have any good feelings toward my friend, her ex-husband. My friend has been thoroughly investigated through the legal system, and has been exonerated of any accusations. Would a therapist really make a diagnosis of someone from afar like this? Is this even ethical? Should yet ANOTHER therapist be asked for an opinion? I know it’s possible this therapist may have some bias she is acting out here, fueled by the hate from an ex-wife, but I wonder how therapists are prepared to deal with their own inevitable biases. Is this something that’s common?
A: Therapists are all too human and come with a unique variety of potential pitfalls, not the least of which is trying to help too much, too soon, in an inappropriate way, or with too little information. Sometimes, in the effort to do what appears to be the right thing, the therapist can make a hasty judgment. When questions of sexual abuse and children are involved many therapists would choose to err on the side of doing too much too quickly than doing too little too late. All this having been said, there is a clear code of ethics for professional therapists. As an example, the American Psychological Association has a very detailed code that is available for review here. It covers a code of conduct for therapists, and will give you some idea of the professional expectations. Other therapists are usually governed by ethics provided by their own organization, or refer to the APA’s guidelines.
A one-meeting diagnosis may sound awful, but without a diagnosis insurance companies will not reimburse. This make the initial evaluation important as it will often require at least a temporary diagnosis to identify the possible cause for the symptoms.
While this diagnosis can change over time, not issuing a diagnosis can create another set of problems.
Perhaps arguably, but most likely, the therapeutic relationship between the therapist and client will ultimately be a causal factor in adaptive changes in the client’s life. This means you should find a therapist you are comfortable with, not someone you feel is out to get you. This means ‘shop around.’ Take your time choosing. This is often a critical time in your life so you want someone to be there for you. For more information on how to choose a therapist check out this article .
Beyond training and credentialing the emotional work of the therapist to reduce their biases is to understand that there may be feelings toward the client that get in the way of therapy. The two articles referenced here and here give
you some guidelines about what to do if you believe you are on the receiving end of a therapist’s bias, or what might be a countertransference, when the therapist transfers feelings from a prior relationship to the client.
A therapist should have had their own therapy and supervision prior to having a practice. While this isn’t a requirement for all therapists, it should be. How else could a therapist possibly know their own blind spots and learn when they are in over their head? Good therapists will at least have peer supervision and colleagues to call when they get in trouble, but of course the therapist needs to know they are in trouble!
What seems clear here is the fact that you deeply care for your friend and his well-being. Perhaps even more than therapy, a caring friend — someone who can help you sort things out and balance yourself when the rest of your world is falling apart — is among the most prized relationships. Your sensitivity to his situation and being available in his corner may indeed be the best antidotes for the slings and arrows of life.
Wishing you patience and peace,
Last reviewed: By John M. Grohol, Psy.D. on 13 Mar 2010
Tomasulo, D. (2010). Is Therapist Bias Common?. Psych Central. Retrieved on May 21, 2013, from http://psychcentral.com/ask-the-therapist/2010/03/13/is-therapist-bias-common/