Is Therapy Only for People Diagnosed with a Mental Health Disorder?

Not everything that is challenging in the human condition qualifies for a mental health diagnosis or needs to be described through one.

A common question asked in my therapy office is: “What is wrong with me?” This question has assumptions that could strengthen the problem that brought the person to therapy. Stigma assumes that people who struggle with mental health have “weak characters,” that it is their fault for experiencing mental distress, and that the fact they are seeking mental health services means that they are irreparably broken as no “sane” person will need to do so.

In reality, all people face challenges, transitions, losses, toxic societal narratives, and intergenerational baggage that could potentially overwhelm their capacity to cope or question their sense of meaning in life. This may sometimes lead to a mental health disorder. But other times their experiences may not fit any of the minimal criteria required to receive a formal diagnosis.

Two diagnostic manuals used by mental health providers are the mental health codes listed in the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Health Disorders (DSM). Other diagnostic models have been promoted but none are as widely used, researched, or covered by insurance as the ICD and DSM. But just because none of our responses fit any of the criteria set by either of the manuals doesn’t make our struggles with the human condition any less real nor does it mean that we cannot benefit from therapy.

Human beings are social beings and were never meant to exclusively face life alone. While independence is a strength, it can also be a weakness when it doesn’t acknowledge that we don’t have infinite capacities which is why at a certain point we need one another. However, our families and friends have limits as to what extent they can support us so this is where therapists can help.

Some therapists see diagnosis as essential in developing a treatment plan but even they don’t believe that everyone who can benefit from therapy has a diagnosable condition. Other therapists don’t use a diagnostic language in their approach to therapy and would rather refer clients to psychiatrists to do a diagnostic assessment if a diagnosis is required or requested. It is not that these therapists don’t believe in diagnosis, but that they would rather focus on the client’s individual experiences than to let a diagnostic label be the only thing dictating how to approach every client who fits that label. They prefer to honor the client’s choice in how they label their experiences and to explore what that means to them.

Regardless of diagnosis or lack thereof, it is important to ask yourself the following:

• Imagine if you have never been exposed to self-help books, self-help posts on social media, or whatever diagnosis you have heard of:
  1. How would you personally name the problem you are facing?
  2. What does naming the problem this way do for you?
• If you have been diagnosed:
  1. What about the diagnosis describes or doesn’t describe your experience and why?
  2. What impact, whether positive, negative, both, or neither, has receiving a diagnosis had on you?
• If the diagnosis meaningfully captures your experience but shame is preventing you from claiming it:
  1. If shame could speak, what would it say?
  2. Is shame on your side or on the side of stigma? How so?
  3. If shame magically disappeared, how would you be relating to your diagnosis differently?