I find formal DSM diagnosis useless. It is a remnant of the medical model, which I call upon psychologists to discard. Our embrace of the medical model was a “deal with the devil”. However, lucky for us we can still get out souls back. Clients come to us, not with medical illnesses, but rather with problems in living. If someone comes to you with a medical illness seeking help, then refer to a physician, because that type of treatment is outside our expertise.
What we can address our issues where patients are stuck in some way that they define as dysfunctional. I emphasize that they define as dysfunctional. Fisch and Schlanger in their excellent book, “Brief Therapy with Intimidating Cases makes this point clear. They state, ” We see problems as behaviors that someone strongly considers undesirable, rather than as manifestations of pathology. They depart from a framework of normality and abnormality, and instead are complaint based.
In this context we can ask about what is it that the client is complaining about rather than asking ourselves what is the proper diagnosis. We are now dealing with what the client wishes to deal with, rather than serving as the behavior police, attempting to get clients to act according to some norm. This is instant culturally sensitive therapy, because we are not laying our values on the client. Also, this allows for greater client-therapist cooperation as resistance is reduced. What is it that the client is complaining about is an excellent place to start treatment, and very natural for most clients.
As simple question to get this information is, “What is the problem that brings you in now?” Now is very important, because we can only deal with ongoing difficulties not change what has happened in the past.

