cLike any health professional, with registration granted by the Ministry of Health, under the law of professional practice, in this case Psychology or Lic. in psychology, professionals are not exempt from the use of diagnosis in one of our areas of work, the clinician. Just as a clinical doctor (or any other specialty of medicine) is required to begin an evaluation process before administering a treatment to arrive at a diagnosis, it is also the duty of the psychologist to carry it out since it will allow us to choose. the most appropriate treatment for that patient. Needless to say, said treatment, for ethical, professional, good practice and scientific attitude reasons, must be validated for the problem or disorder that the patient suffers from.
What does validated or valid treatment mean?
It means that it has been a treatment that has demonstrated its effectiveness for the problem presented by the patient, that it has been investigated, replicated and everything that a previous investigation of a treatment implies (construct validity, reliability, internal and external validity, presence of control groups and a long etcetera). In short, if someone goes to a doctor’s office with a case of acute sore throat, he or she will examine them using appropriate instruments, such as a throat swab, in this case, and an interview, to determine the diagnosis. Continuing with the example, suppose that the professional diagnoses “Bacterial pharyngitis” caused by bacteria problem effectively and relieve the sore throat suffered by the patient.
So why is diagnosis important?
- Because if there had not been a diagnosis, effective treatment could not have been administered for what ails the patient.
- Furthermore, if it had been diagnosed, but without using evaluation instruments, still reaching an approximate diagnosis but without knowing the origin of the pharyngitis (viral or bacterial), there would be a high probability that the prescribed treatment would not be appropriate for that patient. . This could mean higher cost and less benefit to the patient.
- Continuing with the example of the doctor, he must do an environmental analysis to rule out relapses, take into account other variables, prevent contagion and promote healthy behaviors or habits so that the patient does not contract the disease again, if there are habits or behaviors. that could lead to this (unhygienic habits, etc.)
But what would happen if the professional had decided to apply, alluding to the cause, energetic issues of enigmatic origin, using constructs that have never been investigated as an “energy zone” or “chakra” of the body? Here we would be in the presence of professional malpractice, the application of an unvalidated treatment that would supposedly promise to alleviate or cure the patient’s problem with the laying on of hands by a professional expert in the area, in the affected area.
These types of practices, like others observed in medical and psychological science, are part of what is considered malpractice and would be included in the so-called pseudosciences, esotericism, mysticism, etc. Malpractice is a term used to refer to professional responsibility for acts performed. The best known form of malpractice is negligence, which would result in poor management “by action or omission” in the prescription of medication or manipulation of the patient’s body (in an operation, for example) in order to claim responsibility for the doctors in the problems that may have arisen from there. However, the same definition also applies to other professional fields such as law, public accounting, notary writing, and psychotherapeutic treatment administered by psychologists or psychiatrists.
Therefore, it is punishable, or at least denounceable, since he is a health professional and must use scientific knowledge and the best tools available to care for people, seeking to alleviate their suffering, improve their quality of life and, before all, primum non nocere, avoid harming with our actions. Applying an unvalidated treatment and charging for it is harming patients with actions. If the patient wants to expose himself to this type of esoteric, mystical or practices without evidence of effectiveness, there are people who are dedicated to administering them; But if you go to the scientific community, you should be offered the most appropriate tools available for your problem or query, as I mentioned above. Having the title of doctor, graduate, or similar does not endorse the treatment we are administering, that is an error, or a belief. If a person with a Nobel prize maintains that the earth is square, he does not evidence her claim at all, but the authority that this person may represent for certain people can be confused with a valid and studied claim. Since this is not the case, validity is confused with “argument from authority.” Today we see a lot on television, certain characters with media fame stating or explaining from science issues that are only supported by the argument of authority, and that they are generally simple opinions not based on research.
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And what about psychology?
In our clinical setting the same thing happens, the therapist, psychologist or psychiatrist with clinical psychotherapeutic specialization must be trained, updated and administer the most effective treatments, giving the patient the treatment options that have shown effectiveness for what they suffer from. Then the diagnosis would not only serve to administer the appropriate treatment but also be a tool to:
- Use common and understandable language within the scientific community.
- Allow specific criteria for conducting investigations.
- Promote more fluid work in interdisciplinary teams.
To investigate, for example, it is necessary to start from groups carrying out diagnosis, as mentioned (2007), who decided to focus on the , and create the: “Since from the National Institute of Mental Health (NIMH) it was unlikely to investigate a problem without corresponded to an identifiable disorder, I had to focus on a disorder and not just the behavior. That’s how I chose borderline personality disorder, because those people have a much more serious condition and because borderline personality disorder has a very high suicide rate.
Question:- The diagnosis of BPD is a controversial issue. There are even those who believe that what we diagnose as BPD are nothing more than serious forms of other disorders. What is the basis for considering this nosological entity?
Linehan’s Answer: First and foremost, I treat BPD because it can be reliably diagnosed and is differentiated from other disorders. Just because someone meets the criteria for both borderline personality disorder and other personality disorders does not mean that they do not have a disorder characterized by meeting the diagnostic criteria for multiple disorders. However, I’m not interested in whether BPD is a separate disorder or not, but in severe and complex disorders, and BPD “fits the criteria”, multiple and severe disorders also “fits the criteria”, and that is my main interest and, in particular, suicidal behavior. But recently I have also become interested in any serious loss of behavioral control.”
In psychotherapies there are treatments that are not evidence-based, that is, they are not supported by research. These approaches without evidence, not only do they not give results (or, if they do, they are usually due to common causes of all treatment or variables external to it), but they can be iatrogenic, generating psychological damage in patients, due to the inadequate approach. of their problems. An example of this is the monthly sessions of family constellations, past life therapy, treatments that in Chubut (province of Argentina) They are already prohibited from being carried out by psychologists, considered malpractice. Likewise, psychoanalysis, which has not yet been banned but according to guides such as those of the and the (English and American effective treatment guides to mention just a few), more than 75% of the treatments suggested for certain disorders are cognitive-behavioral, the rest of the percentage are specifically cognitive, or specifically behavioral, there are also some psychodynamic treatments, to which rated as “probably effective” and only in the family approach of patients with schizophrenia. With the exception that the psychodynamic treatment in the US is not the same as that carried out in Argentina. Even though it is not regulated, psychoanalysis continues to be administered by psychologists for different problems, and is not recommended by international treatment guidelines.
But why do these types of treatments continue to be used without evidence? I believe that there are multiple variables that contribute to this problem: negligence by omission, lack of updating of therapists, personal tastes (negligence of action), lack of ethics, health policies and a long etcetera. It would be the doctors’ reiki, with which those of us who work with evidence-based treatments find patients who, after 15 years of trying to treat a simple panic disorder, turn to a therapist who works with scientific psychology to resolve the problem. problem. As your social ties deteriorate, your disorder and your quality of life become chronic, treatment becomes much more difficult, but not impossible.
Diagnostic studies allow us to know the course, the percentage of remission, prevalence, comorbidity, percentage of relapses, etc.
The patient and the diagnosis
Of course, the diagnosis is not the person, nor the person the diagnosis. The diagnosis refers to groupings of symptoms that allow consensus to be reached and communication between professionals to be improved, which is why case conceptualization is used in evidence-based psychotherapies. , which in addition to the patient’s summarized history, their data, events, vulnerability, triggers, activators, maintenance behaviors, family, work, academic context, etc., includes the clinical diagnosis, the psychometric instruments used, if they comply criteria, we observe how the symptoms manifest in that patient, both their behaviors and their dysfunctional cognitive processes, based on psychometrics and interviews.
The patient must be informed of the diagnosis and the most recent treatments…