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Evidence-Based Mental Health Disorder Diagnosis: How It’s Done from a Clinical Perspective

Evidence-Based Mental Health Disorder Diagnosis: How It’s Done from a Clinical Perspective

For individuals that are taking the first step to seek help from mental health professionals, it is natural that they may be concerned with the possibility of a misdiagnosis, or perhaps an overdiagnosis. With the pre-existing stigmatisation of mental health disorders, clients would have needed to pluck up their courage to seek treatment in the first place. A misdiagnosis could not only hinder them from receiving the appropriate treatment for their affliction, but also allows for their distress to grow unchecked as their hope for recovery diminishes. In other words, accuracy in evidence-based mental health diagnosis is crucial, and this article aims to help you better understand how the diagnostic process works.

As the term “Evidence-Based Diagnosis” implies, psychiatrists or clinical psychologists take extra care to ensure that any diagnosis made is accurate, objective, and not subject to any form of personal bias. In some sense, this also means allowing for a safe, non-judgemental and compassionate environment. Primarily, clinicians would have to understand the client’s suffering and situation, before thinking about how that might relate to a possible mental disorder. Perhaps you may be unaware of this – clinicians do not simply jump straight into tying the client down with a specific diagnosis of a mental disorder. Before all else, clinicians have to consider if the client’s symptoms meet the definitions of a mental disorder in the first place. As per the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the definition of a mental disorder considers these five factors:

  1. A behavioral or psychological syndrome or pattern that occurs in an individual
  2. Reflects an underlying psychobiological dysfunction
  3. The consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)
  4. Must not be merely an expected response to common stressors and losses (i.e.. the loss of a loved one) or a culturally sanctioned response to a particular event (i.e. trance states in religious rituals)
  5. Primarily a result of social deviance or conflicts with society

With reference to the definition of a mental disorder, it is particularly important to note that the consequences of a mental disorder is clinically significant, and causes a weighty amount of disruption to one’s lifestyle and day-to-day activities. For example, it is completely natural for one to feel upset over certain situations, and this does not necessarily mean that you have a case of depression. However, you might need to get it checked out if you find yourself unable to cope with prolonged feelings of sadness which start to interfere with your daily activities, or are causing you to have suicidal thoughts.  

Of course, clinicians then assess the syndrome one displays. By “syndrome”, we mean a collection of signs or observable aspects of the client’s suffering (i.e outward expression or behaviour). The main point of this is to identify if the syndrome is clustered in an identifiable pattern that is noted to be severe or pervasive. During the assessment phase, clinicians also try to understand the internal experiences of the client. Besides their outward display of distress, their thoughts and feelings are also important information which counts towards the diagnosis of certain disorders. Upon identifying that the client is indeed suffering from a mental condition, clinicians then try “assigning” the client to a particular category. You can think of it as, “can the syndrome be broadly identified?” There are certain broad categories of disorders, such as anxiety disorders, or psychotic disorders. Needless to say, clinicians have to consider which category the client best fits in.

The last step of the diagnosis process concerns the further narrowing and identification of the specific disorder – branching out from the broader, generalised category and into the specific details. For example, a client could be diagnosed with Obsessive-Compulsive Disorder (OCD), a form of an anxiety disorder. Ideally, a specific disorder is identified during the diagnosis process for various reasons – for the sake of the clients themselves, but also for clearer communication with other mental health professionals (in the case of continuity of care), and even for legal or court matters. Under rare circumstances, some clinicians are able to identify the broad category of the mental disorder, yet are unable to specify the exact condition that the client is suffering from. In cases like these, their disorders will be labelled as “unspecified”, as per the 10th version of the International Classification of Diseases. 

As mentioned, evidence-based mental disorder diagnosis is all about diagnosing clients accurately and objectively. To enhance objectivity, some clinicians go the extra mile, stopping to consider if the diagnosis given was biased, or influenced by his or her own culture and history. “Is the syndrome maladaptive?”, “Did I take cultural variables into account?” An objective diagnosis will certainly go a long way in ensuring that the client receives the most appropriate treatment, which will in turn enhance his or her recovery journey. 

Overall, it is safe to say that it takes two hands to clap in every treatment process. Clients and clinicians should try as much as possible to work together, be it in the assessment or treatment phase. For an effective treatment, clinicians will do their best to assess the severity and pervasiveness of any syndrome using understandable language such that clients are well aware of their condition. However, clients also need to understand that transparency on their side is pivotal and that it will drastically impact the treatment process, for better or for worse, depending on their cooperativity and how much they choose to reveal. 

 


References:

Dr Robert Shwartz, Ph.D., PCC-S, Evidence-Based Mental Disorder Diagnosis: How to Increase Accountability, Efficiency and Objectivity, video recording, Mental Health Academy

<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/evidence-based-mental-disorder-diagnosis-how-to-increase-accountability-efficiency-and-objectivity> (Accessed 11/09/2020)

How Do You Find The Right Therapist For You

How Do You Find The Right Therapist For You

For many individuals, therapy is a rather intense and personal topic, and it could have taken them a lot of courage to finally seek the help that they need. Keeping this in mind, it is exceptionally crucial that one finds the right therapist, for there’s a pre-existing implicit clinical belief that the level of treatment effectiveness is greatly dependent on the therapist-client fit. Of course, every client would love to be able to – ideally – find that one therapist whom they can fully open up to from the very beginning, but in reality, that may not be the case. At times, it is necessary to assess your relationship with your therapist and evaluate if there’s the good rapport you need for your sessions to be a success. Ultimately, it boils down to whether you feel a steady, reliable and safe connection with the therapist, and whether you are making the progress you hope for. 

To give you some background, studies over the years have shown that the more similar the therapist and the client, the higher the rate of recovery. As an example, an assessment instrument entitled the “Structural Profile Inventory(SPI)”, which measures seven “independent yet interactive” variables (behaviours, affects, sensory imagery, cognition, interpersonal, drugs/biological factors or BASIC-ID), showed that client-therapist similarity on the SPI predicted a better psychotherapy outcome for the client as measured by differences pre- and post-treatment on the Brief Symptom Inventory. Moreover, the demographic similarity between therapist and client facilitates positive perceptions of the relationship in the beginning stages of treatment, enhances commitment to remaining in treatment, and at times can accelerate the amount of improvement experienced by clients. More precisely, it can be said that age, ethnicity, and gender similarity have been associated with positive client perceptions of the treatment relationship. With gender and cultural similarities appearing the most strongly preferred among clients, these domains generally enhance clients’ perceptions of their therapists’ level of understanding and empathy, and as a result, sessions are judged to be more advantageous and worthwhile. However, besides these, there are also other means to assess your “fit” with your therapist, and we’re here to discuss just that.

First and foremost, consider if you are seeking help in the right place. Does the therapist you are looking at specialise in the area you are seeking help for? Before we can even touch on the topic of interpersonal therapist-client fit, it is important for you to take the time to do some research on various therapists’ profiles – in other words, to sift through and read up on their respective areas of expertise. Typically, therapists would have their area(s) of specialisation up on their online profile directories. It would be clearly indicated if they specialise in areas such as substance abuse, family therapy, or even anger management. It goes without saying that, for example, it would be inappropriate to consult a psychologist who specialises in child psychology when you’re clearly looking for someone who can help you with your substance-use addiction. With that said, it is to no one’s benefit for you to rush into therapy blindly. 

Once you have chosen the potential therapist that you are most likely to want to have see you through your road to recovery, another essential question you should ask yourself is whether you are comfortable with their suggested mode of therapy. During consultations, you will have the opportunity to enquire about their recommended techniques or treatment methods that will be explored during your subsequent sessions. If you are uncomfortable with any particular process, giving honest feedback and exploring other methods is always an option. However, at any point, you also have the right to seek other therapists who may be able to help you in other ways that don’t put you in a tight spot. After all, therapy is all about having a safe and comfortable space for you to sort out your difficulties. 

When assessing your interpersonal connection with your therapist, make sure to trust your gut. This way, you’ll also be able to track your progress better and to seek alternative help if required. Some questions you can ask yourself are:

  1. Am I satisfied with the current balance of talking and listening with my therapist?
  2. Is my overall therapy experience safe, warm, and validating? 
  3. Am I fully assured that I’m in a non-judgemental space where I can be fully honest?
  4. How much has the therapist helped me to gain greater insight into my own behaviour and thoughts so far? 
  5. Am I becoming more capable of coping (independently) with stressful or triggering situations over time?
  6. Am I noticing more positive changes in myself, as compared to when I first started therapy?

As mentioned, a major deciding factor should also be on whether you find yourself noticing positive changes in your thought cycles and behaviour after a couple of sessions. At the end of the day, therapy should be about working towards achieving your desired outcome, and should definitely not be limited to weekly venting sessions. Although venting and letting out hard feelings can provide temporary relief, it fosters a client’s dependence on the therapist over time and further reinforces the client’s problems. Therapy should instead help you to feel more confident that you’ve developed the relevant skill sets in order to cope with whatever emotional challenges that brought you to seek therapy in the first place.

Naturally, there’s no guarantee that we will find chemistry with the first therapist we meet. The chemistry between people varies, and sometimes it’s just not possible for us to force it. Thus, it is important to remember that a lack of fit between therapist and client is no one’s fault. However, remember that the ball is in our court, and it is within our control to start looking in the right place for the sake of our own well-being.


 1 Herman, S.M. (1998). The relationship between therapist-client modality similarity and psychotherapy outcome. Journal of Psychotherapy Practice and Research, 1998 Winter; 7(1): 56-64.

2 Luborksky, L., Crits-Christoph, P., Alexander, L., Margolis, M., & Cohen, M. (1983). Two Helping alliance methods for predicting outcomes of psychotherapy: A counting signs vs. a global rating method. Journal of Nervous and Mental Disease, 171, 480-491.

3 Jones, E. E., (1978). Effects of race on psychotherapy process and outcome: An exploratory investigation. Psychotherapy: Theory, Research and Practice, 15, 226-236.

4 Blase, J. J. (1979). A study of the effects of sec of the client and sex of the therapist on clients’ satisfaction with psychotherapy. Dissertation Abstracts International, 39, 6107B-6108B.

Beutler, L.E., Clarkin, J., Crago, M. and Bergan, J., 1991. Client-therapist matching. Pergamon general psychology series, 162, pp.699-716. (Accessed 30/08/2020)

https://www.counsellingconnection.com/index.php/2019/12/03/assessing-therapist-client-fit/ (Accessed 30/08/2020)

https://www.nytimes.com/roomfordebate/2013/02/14/think-like-a-pope-knowing-when-to-quit/when-to-quit-therapy (Accessed 30/08/2020)

Photo by Cytonn Photography on Unsplash

The Relationship Between Media Multitasking and Executive Function in Early Adolescents

The Relationship Between Media Multitasking and Executive Function in Early Adolescents

The increasing prevalence of media multitasking among adolescents is concerning because it may be negatively related to goal-directed behavior. This study investigated the relationship between media multitasking and executive function in 523 early adolescents (aged 11-15; 48% girls).

The three central components of executive functions (i.e., working memory, shifting, and inhibition) were measured using self-reports and standardized performance-based tasks (Digit Span, Eriksen Flankers task, Dots–Triangles task). Findings show that adolescents who media multitask more frequently reported having more problems in the three domains of executive function in their everyday lives.

Media multitasking was not related to the performance on the Digit Span and Dots–Triangles task. Adolescents who media multitasked more frequently tended to be better in ignoring irrelevant distractions in the Eriksen Flankers task. Overall, results suggest that media multitasking is negatively related to executive function in everyday life.

To read the full article: http://jea.sagepub.com/content/early/2014/02/17/0272431614523133.abstract

Written byLisa van der Heijden, Clinical Psychologist, Susanne E. Baumgartner and Wouter D. Weeda.

Contact Promises Healthcare if you are interested to know and learn more therapy for children/adolescents.

Myth Busting Mental Health – Youth Suicide

Myth Busting Mental Health – Youth Suicide

youth-suicideLet’s take a look at some common mental health myths about youth suicide and set the record straight.

Attempted suicides are just a cry for attention.

A suicide attempt should never be dismissed as ‘just a cry for attention’. A young person is highlighting that their level of internal distress is unmanageable and unbearable. They need help, not judgement. A young person can feel even more isolated and misunderstood if those around them fail to take their actions seriously. Never ignore or minimise suicidal behaviours and seek professional help as soon as possible.

Teens who cut their wrists must be suicidal.

Cutting is a form of self-injury that can either be suicidal or non-suicidal. In both cases, the cutting is a sign that a young person is not managing their internal distress in a healthy way. Any young person who self-injures should undergo a full suicide risk assessment by a registered mental health professional.

If I ask a young person whether they are feeling suicidal, it might put the idea in their head.

This is a particularly dangerous myth as it discourages discussion of the issue at hand. Talking about suicidal feelings will not encourage a young person to commit suicide. When having the conversation try to stay calm and non-confrontational. Remain open and genuine, and remember the overall message – it is ok to talk about feelings, and there is help available. Show that you care and avoid judging the young person. If you are uncomfortable or unsure about having the conversation, get in touch with a mental health professional for some tips and guidance.

Written by Leeran Gold, Psychologist in our Forensic Service.

At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. If you or someone you know needs mental health support, please contact us today for inquiries and consultations.

For after-hours crisis support contact your local mental health service or emergency services.

In Singapore: IMH 24-hour helpline +65 6389 2222, Ambulance 995.

Working with clients who grapple with sexual compulsivity

Working with clients who grapple with sexual compulsivity

Register Today

This is an introductory workshop presented by Samuel Lee on the various theories of sexual compulsivity ( also sometimes referred to as ‘sexual addiction’) and its development.

Case studies will be shared to illustrate how various psychotherapeutic interventions can be applied when working with such clientele.

Target Audience

This course will be useful for all those in helping professions like counsellors, doctors, social workers, therapists, psychologists, psychiatrists, and also lay people working with addictions.

Date:  11th May 2016

Cost: $60 ( before GST)

Register at http://events.promises.com.sg/event-planner/

The Wonder of Spontaneity

The Wonder of Spontaneity

For those of us who experience life as monotonous and rather soul-sucking there’s good news!

Through accessing your spontaneity and creativity you can feel ALIVE.

Our psychodrama and sociodrama workshops assist the return of playfulness and fun.

One of the participants, Geralidine, commented “In my first workshop, I didn’t know what was going on, but the positive energy drew me in and soon I was participating in a positive way, I lead workshops today to help others find their inner visionary self-lover. This theatre of spontaneity is both rejuvenating and healing”

To find out more about upcoming Psychodrama workshops, please contact our clinic.

Written by: Sharmini Winslow – Therapist, Promise Healthcare