The Usefulness of Diagnosis: Knowing When It Matters

Clients often ask me, “How do I know if this is a problem?” And more often than not, my response—much like many of my graduate school professors used to say—is, “It depends.” But what usually follows is a conversation in which I ask the client to reflect on whether their thoughts, feelings, or behaviors are interfering with their functioning or causing significant distress. These two factors—distress and impairment in functioning—are fundamental for clinical psychologists when considering whether someone meets the criteria for a psychological diagnosis.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which psychologists use to make diagnoses, virtually every disorder requires not only the presence of specific symptoms but also evidence that the condition causes clinically significant distress or impairs functioning. These criteria are important starting points—but they’re not the whole picture. I believe therapy should be individualized. The DSM was developed to provide a common language for mental health professionals, not to capture every nuance of human experience. Two people with the same diagnosis may present with very different symptom profiles. Oftentimes, a person may have a co-occurring diagnosis that significantly alters how treatment is approached. Overlap in symptoms does not necessarily mean overlap in treatment needs.

In graduate training, we are taught that “diagnoses inform treatment.” While I wholeheartedly agree with this statement, diagnosis is only one piece of the puzzle. It is also essential to consider the unique context and identity of the person sitting across from us—and to be thoughtful about how a diagnostic label might affect their self-perception. That takes clinical judgment, cultural awareness, and an empathic mindset.

In my own psychology practice, I have found that there are times when discussing a diagnosis is vital to building insight, promoting treatment engagement, or even strengthening rapport. At other times, focusing on a diagnosis may be unnecessary—or even counterproductive. In these cases, it is up to the clinician to decide whether discussing the label would be helpful or harmful.

For example, I once worked with a client who had previously been diagnosed with Autism Spectrum Disorder by another clinician. He and his parents firmly disagreed with that diagnosis. Whether or not I personally agreed with the label, I recognized that the diagnosis had become a source of tension and distress. Moreover, my treatment approach would not have changed regardless of whether we chose to explore the validity of the diagnosis. Instead, I used their disagreement as a way to build rapport, demonstrate respect for their perspective, and align myself with their experience. Doing so helped to foster trust and engagement—not just with the parents, but also with the client, who had been skeptical of therapy from the outset.

Ultimately, I view diagnosis as one of many tools that I use to help clients—it can be useful, but it isn’t always necessary (setting billing considerations aside for the moment). Many clients appreciate this flexible approach. Some come to therapy already holding a diagnosis; others seek out therapy specifically for diagnostic clarity, such as during psychological evaluations. The key is clinical discernment. As psychologists, it is our responsibility to assess what serves our clients best. Sometimes that means focusing on a diagnosis; other times, doing so may be unnecessary—or even counterproductive. In the end, we hold significant responsibility in guiding clients toward growth, and that requires knowing when a label helps, and when it doesn’t.