The Art of Diagnosis
Although a large component of the daily work of social workers is to diagnose psychiatric illnesses, there is little education on how to do that well. There is a wealth of knowledge about each disorder, but there is a lack of training on what questions to ask a client in order to properly develop a thorough and accurate diagnosis. This training teaches how to differentially diagnose using specific questions and provides decision trees that clinicians can use in clinical sessions.
Clinical diagnosis may seem safe from cultural, political, and social influence, but in fact it is often guided by these forces. Whether a condition is considered a disorder is based in social and political context, and certainly what questions we ask in the psychiatric interview is culturally influenced. If one were to examine diagnostic material across decades the fluctuations in diagnostic material would be easy to detect and correlate with changes in cultural, social, and political climates.
This training has obvious innovations in direct practice, as it aims to help the clinician improve the diagnostic skills they use in their daily practice. Decision trees given in the DSM or in past trainings are updated and expanded to better serve the clinician. This training topic connects to diversity in allowing for individuality in diagnosis and attending to the diverse background of each client as a part of the diagnosis process. It connects to ethics because an important component of the code of ethics is client welfare, which includes making an appropriate diagnosis. It connects to advocacy because misdiagnosis is common, as is “lazy diagnosis” (simply writing down a previous diagnosis as one’s current diagnosis without adequately examining the client), and this training will teach attendees how to argue for a better representation of the presenting diagnosis, which strengthens both the individual client’s treatment experience and the profession as a whole.
This training employs a specific interactive powerpoint presentation that simulates several clinical interviews and how to employ questions to get at the proper diagnosis in each case. In addition, a significant learning experience will occur in the discussion between the lecturer and the attendees, and handouts of decision trees will be provided for attendees to take with them.
1. Learn the art of diagnosis, gathering specific questions that will aid the clinician in obtaining the most accurate diagnosis with each client.
2. Practice the clinical interview, asking learned questions to aid in differential diagnosis.
3. Obtain decision tree handouts of each disorder group to use in the clinical interview.
Suggested Reading List
Blackman, J.S. (2010). Get the diagnosis right: Assessment and Treatment selection for mental disorders. New York: Routledge.
Hasin, D., Samet, S., Nunes, E., Meydan, J., Matseoane, K., & Waxman, R. (2006). Diagnosis of comorbid psychiatric disorders in substance users assessed with the psychiatric research interview for substance and mental disorders for DSM-IV. American Journal of Psychiatry, 163: 689-696.
North, C. & Yutzy, S. (2010). Goodwin and Guze’s psychiatric diagnosis. New York: Oxford University Press.
Maj, M., Gaebel, W., Lopez-Ibor, J.J., & Sartorius, N. (2002). Psychiatric diagnosis and classification. West Sussex, UK: Wiley & Sons.
Massachusetts General Hospital and McLean Hospital Residents and Faculties (2009). The Massachusetts General hospital/Mclean hospital residency handbook of psychiatry. Philadelphia: Lippincott Williams & Wilkins.
Meyer, R.G., & Weaver, C.M. (2006). The clinician’s handbook: Integrated diagnostics, assessment, and intervention in adult and adolescent psychopathology. Long Grove, IL: Waveland Pr Inc.
Salloum, I.M., & Mezzich, J.E. (2009). Psychiatric diagnosis: Challenges and prospects. West Sussez, UK: Wiley-Blackwell.