NORMAL OR NOT? WHO SAYS AND WHY If this is your first visit to SHRINKS THINK please start at the beginning of the Normal or not series by clicking here:
KATHERINE GORDY LEVINE’S SHRINKS THINK NORMAL OR NOT LECTURE NOTES I taught various graduate level Human Development Courses for many years at Columbia University’s School of Social Work. I was one of the first social workers allowed to teach one of those courses; for years only psychiatrists were allowed to teach this course. I always gave my students extensive Lecture Notes. This series is based on those notes. I spent lots of years learning, hope what I give back is valuable to someone and my need to share is healthy narcissism.
REMEMBER YOU CANNOT DIAGNOSE YOURSELF OR A LOVED ONE, IF YOU ARE WORRED ABOUT YOUR OR SOMEONE ELSE, SEEK PROFESSIONAL HELP.
NORMAL OR NOT? PART VI
PUTTING IT ALL TOGETHER Intake is over. Intake or the assessment period refers to the time shrinks spend gathering information and deciding what diagnosis will be approved by the insurance companies or can prevent law suits. if the client decides we have not done our job properly.
By the way, not all practicing shrinks follow this model. Most psychiatrists do; if you are licensed by a state as a therapist this is the model you are expected to follow. The information gathered should be put into a written format declaring the assessed person normal or not and issuing a plan of action, most often called a treatment plan. For this part of the examination, the following format is usually followed.
PRESENTING PROBLEM—WHAT BROUGHT THE PERSON TO THE ATTENTION OF A CLINICIAN AND THE NEED FOR A MENTAL HEALTH ASSESSMENT. Often this is not agreed upon and any disconnect between the individual being assessed, the referral source, and the assessor needs to be resolved and mutual goals set.
- A BRIEF RECAPITULATION of the overall clinical picture and a mention of differential diagnosis.
- DSMIV DIAGNOSIS Which involves five axis, formal diagnostic terms and the numerical codes attached to the designated diagnosis. Here are the five axis:
- Axis I codes the main psychiatric diagnosis and symptom disorders. This refers to acute symptoms that need treatment. The list is long and ranges from depression to psychosis, to eating disorders to learning disabilities.
- Axis II codes personality disorders and mental retardation, conditions that continue throughout one’s life. Personality disorders are those aspects of our being that some call character, but they are considered a more build in part of the person’s being and less amenable to change. When thinking of a personality disorder it is thought best to state rule out (R/O) until the person has been seen over a long enough to validate the presence of a personality disorder. Not to be used with children, although some do.
- Axis III is for noting general medical conditions that are significant to the psychiatric condition or affecting the patient’s current functioning. This is often over looked by the psychologically minded clinicians despite the fact that many mental disorders originate as a response to medical disorders. Depression is a prime example. Mere physical illness can create depression like symptoms; so can certain treatments for physical illnesses.
- Axis VI note psychosocial stressors. Too often over-looked or not commented on. Many mental health problems are related to the stressors of living in stressful situations.
- Axis V indicates the degree to which the clinical distort impairs functioning through the use of the Global Assessment of Functioning. This is also often overlooked.
3. Treatment plan including any planned diagnostic tests, therapy, referrals to other professionals and the time the client is to be seen again.
DIAGNOSIS IS A STORY AND AN IMPORTANT ONE TO BE FAMILIAR WHETHER YOU ARE THE EVALUATOR OF THE PERSON BEING EXAMINED. ALL SUCH STORIES ARE PART OF A PICTURE BUT NOT WHOLE TRUTH AND SOMETIMES NOT EVEN A PARTIAL TRUTH.
CONSUMER ADVICE. Seeing a shrink? Taking your child to see a shrink? Ask for a copy of all written material. This used to be forbidden, but it is about you or a loved one you are responsible for and now you are entitled to it. You are also entitled to be present at all meetings about you or a loved one. As one advocacy group says “Nothing about us with out us.”
SOURCES OF MORE INFORMATION
The Federal Government’s Web Page offering information on Substance Abuse and Mental Health Services
CommunityAlliance for Ethical Treatment of Children