Assessment, Diagnosis, and Research
"A good case conceptualization should effectively link a client’s presenting problem to a treatment plan as well as provide the basis for tailoring treatment to client need and expectations" (Sperry, 2005, p. 1). Additionally, case conceptualization embraces a holistic perspective of the client that includes understanding the client's issues as well as "the how and why the problems have developed" (Mears, 2010, p. 269). Without this comprehensive approach to mental health counseling, it is unlikely the client will be treated effectively.
Importance of Assessment and Diagnosis
In Case Conceptualization
Assessment and diagnosis are pivotal in case conceptualization. Accurate assessment and diagnosis help to form an overview of the client and contributing circumstances. Without a thorough assessment, it would be difficult to develop an overall perspective and comprehensive treatment plan. Assessing the client's general thinking and reasoning skills, behavioral issues, interests, and personality provide the perspective necessary for comprehensive case conceptualization.
To gain information significant to the client's personal circumstances, care must be taken to implement the most appropriate assessment, and one that is valuable and in the best interest of the client (Mears, 2010). Ultimately, integrating "the information gathered during the assessment with counseling and developmental theory, as well as diversity and social justice issues...leads to (a) diagnosis and effective treatment planning" (Mears, 2010, p. 283). As part of the case conceptualization, the diagnosis is essential to determining the treatment as well as the goals of any intervention. Without a definitive diagnosis, it is difficult to have a holistic grasp of the client, her circumstances, and the plan for intervention and recovery.
When a client is treated by multiple health care professionals, the assessment and diagnosis create a common language by which medical professionals care for the client. For example, in the case of an individual with bipolar disorder taken to a hospital because of severe mania, without understanding the pre-existing diagnosis of mental illness, the doctor may not fully understand how to treat the patient appropriately. Furthermore, most insurance companies require a definitive diagnosis for reimbursement for mental health services rendered to the client.
In Treatment Planning
According to Mears (2010), "a good treatment plan requires an assessment appropriate to the client's presenting concerns and a case conceptualization that includes an understanding of what the problem is, how it developed, and how to deal with it" (p. 291-292). Diagnosis and assessment provide guidance and direction toward evidence-based intervention and treatment. For example, if an individual presents with a nebulous set of symptoms and without substantiated diagnosis, choosing an empirically-derived treatment is difficult. Furthermore, the assessment and diagnosis give the client and counselor a focus in the scope of treatment planning and helps establish goals and strategies for the counseling intervention. Additionally, the diagnosis helps the client to more accurately understand his needs as well as how the treatment plan will work toward his recovery.
For insurance purposes and in managed care settings, a formal diagnosis, usually defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM-IV-TR) (American Psychiatric Association, 2001) as well as an evidence-based treatment plan is required for reimbursement for continued mental health counseling (Mears, 2010). In cases in which collaboration is necessary for treatment planning, case conceptualization creates a common language to describe the client's overall circumstances, treatment goals, interventions, and outcomes, as well as a holistic description of the client (Bufford, 2008). For example, when a mental health counselor refers a client to a psychiatrist or other mental health care professional, the case conceptualization will provide sufficient information on every aspect of the client.
Repercussions of Misdiagnosis
Intentional misdiagnosis or misdiagnosing to obtain necessary coverage for a client is unethical and illegal. Such action is a flagrant violation and a breach in the commitment to ethical behavior as described in the American Counseling Association (1995) and the American Mental Health Counselors Association (2000). Mental health counselors can have criminal charges brought against them and lose their reputations as well as their licenses (Braun & Cox, 2005). Aside from the legal and ethical ramifications, negative effects for the client include stereotyping by others (including health care professionals) because of the labels used in diagnosis (Mead, Hohenshil, & Singh, 1997).
For example, in the case of children diagnosed with attention deficit disorder, teachers associated with the child may develop preconceived ideas and anticipate behavior, leading to a cycle of self-fulfilling prophecy of negative behavior by the children in response to the teacher's expectations. Furthermore, a mental health diagnosis or misdiagnosis on an individual's medical record is a permanent entry and one that can affect one's employment, promote stereotyping by others, and represents a preexisting condition for future health insurance claims.
When taking any first step, it is necessary to identify one's footing, how one arrived at their current destination and intended direction, and how they will proceed. Assessment and diagnosis are central to case conceptualization and treatment planning, and in essence, pivotal in client intervention and healing.
American Counseling Association. (1995). ACA code of ethics and standards of practice (6th ed.). Alexandria, VA: Author.
American Mental Health Counselors Association. (2000). Code of ethics of the American Mental Health Counselors Association. Journal of Mental Health Counseling, 23, 2–22.
American Psychiatric Association (2001). Diagnostic and statistical manual of mental disorder (4th ed., text revised). Washing, DC: American Psychiatric Association.
Braun, S. A., & Cox, J. A. (2005). Managed mental health care: intentional misdiagnosis of mental disorders. Journal of Counseling & Development, 83(4), 425-433.
Bufford, R. K. (2008). Escape from Alcatraz: Finding safety and peace. Journal of Psychology and Christianity, 27(1), 66-72.
Mead, M. A., Hohenshil, T. H., & Singh, K. (1997). How the DSM system is used by clinical counselors: a national study. Journal of Mental Health Counseling, 19(4), 383-402.
Mears, G (2010). Chapter eleven: Assessment, Case Conceptualization, Diagnosis, and Treatment Planning. In Erford, B. (Ed.) Orientation to the Counseling Profession: Advocacy, Ethics, and Essential Professional Foundations (p. 269-297). Upper Saddle River, NJ. Pearson Education, Inc.
Sperry, L. (2005). Case Conceptualizations: The Missing Link Between Theory and Practice. The Family Journal, 13(1), 71-76. doi: 10.1177/1066480704270104