Carolina Partners In Mental Healthcare, PLLC

4 Reasons Why We Diagnose - Michael Goulding, MSW, LCSW

There is ongoing discussion on labeling or pigeonholing people. Positive psychology and life coaching have been in the forefront, offering solutions to challenges instead of labeling problems. Evaluating a client has its place and can serve many purposes if we understand the true meaning behind diagnosis.

Common Ground

When we use terms like depression, obsessive-compulsive and attention deficit hyperactivity disorder most of us think about many of the similarities that correspond with these diagnoses.

One of the most obvious reasons for diagnosis is that it provides us with a common language to describe the client’s symptoms. This is very helpful in collaborative conversations with other clinicians and is a more descriptive way to communicate.


Diagnosis = Dia means discernment and Gnosis means knowledge or knowing. An example of vague terminology is when the military assessed American men for their mental health during World War I. Assessments revealed fifty percent of the men to be “feeble minded”, because it was the best term they had to describe mental illness. This term was not sophisticated enough to discern between severe medical issues of schizophrenia treated through medication and diagnoses treated by talk therapy such as trauma. An accurate diagnosis helps identify the presenting issue.


Generally speaking, insurance companies don’t like to reimburse clinicians for services unless there is something “wrong” enough with the client. It is not enough for a teenaged daughter to be struggling with her mother for the insurance to reimburse a clinician to resolve those issues. In order to get reimbursed the clinician must find something “wrong” with either the mother or the daughter.

The Ultimate Purpose of Diagnosis

The goal behind diagnosis is to help people get better. Sometimes clinicians can help a client by identifying a person as ADHD, giving him access to a stimulant and having the symptoms decrease within an hour of taking the medication. Sometimes, within a session, a therapist can reduce the symptoms of trauma the client has been carrying for years.

Often times, the best diagnosis does not come from DSM V or other medical text. Most people often view a diagnosis as something a clinician must pigeonhole someone into a certain “illness” whether it is accurate or not. Sometimes the best diagnosis comes by assessing a situation or dynamic between two people versus symptoms. Sometimes a diagnosis means identifying how a husband tries to problem solve for his wife when she merely is seeking validation.

Sometimes diagnosis is being open to a systems approach. One of my nine year-old clients was overturning desks after the teacher asked him to read from the board. His behaviors did not stop through medication, play therapy or a behavior chart. His behaviors stopped when he got a new pair of glasses and could see the board in front of the classroom.

The important aspect of a diagnosis is helping the client feel better. It is not always easy to tell what causes inattentiveness. It can be ADHD, depression or anxiety, just to name a few.

What begets what? Is the person having attention issues because they are depressed and anxious or are they depressed and anxious, because they are frustrated from having ADHD. Regardless of the actual diagnosis, in the classic sense, it is sometimes best to identify the client’s struggle with organization. In this instance it does not matter what the label is. Modeling organizational skills can help the client to feel better regardless of whatever classic diagnosis is assigned to the client.

Diagnosing can serve the client well when we remember that the goal is to help the client feel better. We can help improve symptoms when we diagnose the appropriate systemic issue, individual symptom or dynamic that lies between people.

Mike Goulding is a licensed behavioral health therapist who has been life coaching for over 25 years including his work on a national crisis team with a Fortune 100 Company. Mike has a unique life management style where he collaborates with you in a solution-focused approach so that you may successfully meet your goals. Unlike counseling, which can focus on healing old wounds, coaching is about moving away from your current situation to being the fulfilled person you desire to be. Because of this solution-focused approach, Mike focuses on what you can do while assisting you to clear away the challenges in your life. Contact him at Carolina Partners in Mental Healthcare, 790 SE Cary Parkway, Suite 201, Cary, NC 27511. Telephone: (919) 443-4100;