“I don’t know if I did the right thing. Maybe I shouldn’t have.”
Power differentials are present within the helping profession and may cause the helpee to feel inferior to the helper, particularly in a client-therapist relationship. Oftentimes, clients are in a position where they feel reliant on guidance from their therapist. If there is a significant power imbalance, clients may be hesitant to ask questions and unsure of their role in the reciprocal helping relationship.
On a Reddit social media post, a female client with obsessive-compulsive disorder (OCD) posed this question: “Can I ask my therapist about my diagnosis?” The client has been working with her therapist who is a psychiatrist. The relationship between the therapist and client is fairly new. During one of their sessions, the therapist mentioned that the client might be autistic but they were unsure. The client was previously tested as a child, but the results did not confirm autism or autistic traits. Because the therapist has not confirmed the client’s diagnosis, the lack of uncertainty is creating terrible chaos in the client’s head, as she would like to know if she is or is not autistic. The client is thinking about repeating this question in her next session but is unsure whether it would be rude, pointless, or wrong. Unsure whether or not her therapist is capable of diagnosing autism, the client has tried to persuade her therapist into revealing a diagnosis, but the therapist redirected the conversation.
“This is something I’ve brought up with reluctant therapists as well. I understand the reasons they may not want to disclose that info to a client, but at a certain point it’s like if you had to go to the doctor every week to get an MRI and they just told you they’re just concerned with working on your symptoms.” – u/HyaAlphard
An article on Informed Consent written by Annette Johns discusses how the Canadian Association of Social Workers (CASW) Code of Ethics (2005) defines informed consent as “a voluntary agreement reached by a capable client based on information about foreseeable risks and benefits associated with the agreement.” Social workers have an ethical responsibility to seek informed consent from their clients at the beginning of the therapist-client relationship. Clients also have the right to refuse or withdraw consent and to have an opportunity to ask questions.
It is also important for clients to be engaged in the decision-making processes throughout the duration of the therapist-client relationship. In fact, informed consent and full transparency are integral to the relationship between a client and therapist and ensures the client’s right to self-determination, autonomy, dignity, and confidentiality. Social workers should use clear and understandable language to inform clients of the purpose, risks, limits, and reasonable alternatives to services.
Receiving a Diagnosis
Clients should be a part of the decision about whether to be assessed for a diagnosis. If the client is willing, the therapist has a responsibility to disclose the advantages and disadvantages of receiving a diagnosis. One advantage is that receiving a diagnosis can be comforting to clients who have been struggling with symptoms. Some clients find relief and feelings of validation when they can put a name to it, as well as decreased guilt, shame, and feelings of isolation. Receiving a diagnosis can also open up resources for the client and strengthen the relationship between the therapist and the client. However, clients should also be informed that diagnoses can stick with people, following them to and beyond adulthood even if they were misdiagnosed.
Suggested Questions to Ask
The client should feel comfortable to ask their therapist questions and express their needs throughout the duration of the therapist-client relationship. When the therapist suggests a “working diagnosis,” it should also be understood that the client is the most important member of the diagnostic process and has the right to obtain clarity by asking questions, taking notes, and being actively involved. Although the questions below are based in the medical profession, they are relevant to all clients. Out of seven questions posed by Helene Epstein, here are four relatable key questions:
What kind of test(s) will I have?
It is important for the client to know what kind of tests the therapist plans to administer. There are many different types of tests and ways to identify the source of a client’s concern.
Why do you think I need this test?
It is important for the client to understand why their therapist is even recommending the test in the first place, as not every test is essential, and some may be invasive or expensive. The client has the right to ask whether there’s an alternative, if it is costly, or if the test is necessary.
What do I need to do to prepare for this test?
While not every test requires specific planning, some might. If this is not communicated in advance, the client may have to reschedule.
When will I get the results?
Depending on the test and other extenuating factors, waiting times for results may vary. Clients should consult with their therapist for more details.
Clients have the right to be fully informed and fully engaged. Although asking questions may seem rude or wrong, it is not. It is important for clients to be informed about decisions being made on their behalf.
Start with these questions and see if they help give you the answers you need. It’s important you use your voice in client-therapist relationships and prioritize your needs. At the end of the day, the treatment your seeking is for you, so do what feels right.