Posted on Feb. 27, 2025

By Dr. Robert W. Caruso, DMin, MDiv, MART, MA, ALMFT

“If you ever recognize the patient, you have already lost them.” I read this anonymous quote in Dr. T. Byram Karasu’s (2001) book The Psychotherapist as Healer, which helped to transform my understanding of the therapeutic profession as ultimately an art form of theory and practice that guide people holistically in mind, body, emotion, and spirit. We often seek answers and solutions through defined categories in our modern world. This usually translates to seeking a diagnosis when it comes to mental, emotional, and spiritual well-being. Most therapy patients today must receive a diagnosis if they use their in-network insurance to pay for counseling services. While a mental health diagnosis can provide valuable insight and access to healing resources, it’s crucial to remember that it’s not always the sole answer, nor is it the only path to healing.

Indeed, science is part of the therapy and counseling profession in helping us better understand human behavior; however, science has limitations when trying to comprehend a person holistically and spiritually. That is, there are uncertainties about the mind that behavioral science cannot grasp because there is so much subjectivity in how talk therapy heals patients. Managed care insurance companies tend to diminish the art of therapy through their reductionistic methods of care that predetermine the goal, process, and outcome timeline for patients and therapists. The medical therapy model emphasizes that healing comes through the correctly administered “evidenced-based” therapeutic methods (i.e., CBT, DBT, etc.). Still, Adlerian and other Humanistic therapeutic frames of reference emphasize the therapeutic relationship as the progenitor of the healing process and the patient as the ultimate judge in their healing process.

While intended to be helpful, the diagnostic process can sometimes unintentionally narrow our perspective. We risk focusing solely on the “label” and overlook the complex, multifaceted nature of the human experience.

Here’s why therapeutic healing cannot ultimately be measured and goes beyond a diagnosis:

1. The individual is Beyond the Diagnosis:

· Adlerian Therapy asserts that counseling should not be illness-specific but person-specific: Every individual’s journey is unique. Two people with the same diagnosis can experience vastly different symptoms and respond differently to a treatment. A diagnosis may provide a framework for healing, but it does not capture the nuances and complexities of an individual’s life experience.

· Strength, social interest, and courage: Focusing solely on symptoms can overshadow an individual’s inherent strengths, relational interaction with others, and overcoming fear and feelings of inferiority through courage and encouragement. Healing involves 

tapping into these other resources, not just addressing and focusing on perceived deficits. Normality is defined by the person and their past and present life experiences.

· Context matters: Social, cultural, and environmental factors significantly impact mental, emotional, and spiritual well-being. A diagnosis may not fully account for these external influences.

2. The Limitations of the Diagnostic Statistical Manual 5 (DSM 5):

· The spectrum of experience: Mental health exists on a spectrum. Diagnostic categories can be rigid, failing to capture the fluidity and overlap of symptoms. Further, it takes time for the therapeutic relationship to evolve so that a more authentic diagnosis can be deciphered by the client and the therapist working as a team to create goals and objectives for them to work towards.

· Subjectivity: Mental health diagnoses often rely on subjective reports and observations. This can lead to variability and potential misinterpretation, especially when insurance companies force counselors to diagnose patients at their first or second session.

· Over-medicalization: Sometimes, typical human experiences like grief, sadness, worry, anxiety, and feelings of shame can pathologized and labeled as disorders, even when they are natural responses to life’s stressors and challenges (e.g., the death of a loved one, starting a new job, moving, going through a divorce, etc.).

3. Adlerian and Other Humanistic Approaches to Healing:

· The therapeutic relationship: It is essential for the patient's healing process because it is built on empathy, unconditional regard toward the patient, trust, and understanding. The therapeutic relationship is profoundly healing, regardless of a diagnosis. Sometimes, we just want someone to hear us, genuinely hear and see us.

· Lifestyle changes: Diet, exercise, sleep, spiritual practices, doing something for others, or taking care of an animal (e.g., a dog or cat) play crucial roles in mental, emotional, physical, and spiritual well-being. These factors alone are often overlooked in a strictly diagnosis-focused approach or make it difficult for a counselor to engage the patient due to strict insurance guidelines limiting counseling sessions to ten or fewer. Moreover, because insurance companies pay master-level counselors the equivalent wage most pedicurists make at local nail salons, they typically carry high caseloads of clients to make a decent living, which can severely limit the quality time necessary to help patients achieve lasting positive change in their lives.

· Spirituality: Most therapists avoid the topic of spirituality and religion for a myriad of reasons, and sometimes rightly so if the patient has experienced or is experiencing religious trauma. However, religion and spirituality affect every person. Sometimes, it gets brought up in counseling, or spiritual practices are highlighted to the patient (i.e., meditation, the 12-step spiritual programs of AA or NA, and discussions on existential topics like aging, death and dying, and vocational callings) can cultivate self-awareness, emotional regulation, and inner serenity, nurturing healing and change from within.

· Creative outlet and expression: Helping patients engage in the arts, music, writing, or other creative outlets can encourage them to process emotions and promote healing.

· Balancing lifestyle tasks of work, loving relationships, social interest and connection, self, and spiritual outlook: Adler once told one of his patients he could help alleviate the patient's depressed mood. The patient was excited to hear that and eagerly asked how Adler could help cure his depression. Adler responded by saying that the patient had the power to adjust his depressed moods. All the patient had to do was something good for someone else every day for three weeks. Social support and interest in others nurture mutual feelings of belonging, which is essential for mental, emotional, physical, and spiritual well-being. Building meaningful connections can be a vital part of the healing process.

4. When Diagnosis is Helpful:

It’s vital to acknowledge that diagnoses can be incredibly helpful for some patients to help them understand themselves better. Obtaining a mental health diagnosis can:

· Provide a sense of validation and understanding.

· Facilitate access to appropriate treatment and resources.

· Help individuals connect with support groups and communities.

The key takeaway is that mental health is complex and multifaceted because humans are complex and multifaceted creatures. While diagnoses can be a valuable tool, they should not be the sole focus of healing. Diagnoses are a tool to help broaden the patients' understanding of themselves and are not meant to define or label them. Adlerian therapists like me believe authentic therapeutic healing involves a holistic approach, acknowledging the individual’s unique experience, strengths, and context. It’s about empowering individuals to cultivate well-being through various pathways within and beyond the boundaries of diagnosis and the therapist’s office.

Ultimately, the journey to mental well-being is a personal one. It requires self-compassion, exploration, and a willingness to embrace the full spectrum of human experience.