Call for papers: The use of diagnosis in clinical psychology

Rivista di Psicologia Clinica (Journal of Clinical Psychology) intends to open a debate on the use of diagnosis in clinical psychology. The second issue of 2018 and the first issue of 2019 will be dedicated to this theme. The position of the editorial team and the direction of the journal is clear with regard to this issue: for a longtime, we have published theoretical works and clinical experiences aimed at calling into question the diagnosis, referring to specific pathologies of the individual, and we have preferred the analysis of the demand; a construct that refers to the relationship between individuals and context, in order to develop interventions addressed to problems brought to the clinical psychologist. However, in this debate we are interested in different positions, hoping to provide the reader with an overview about different scientific opinions on a topic of central interest for the clinical psychological profession. We propose, as an invitation to the debate, some considerations in this regard. Diagnosis is, first of all, a medical act. The etiopathogenetic diagnosis establishes the entire medical intervention, which can be synthesized in the following triad: diagnosis - prognosis - therapy. Prognosis and therapy are possible only if the doctor is able to diagnose the disorder reported by the patient, if s/he is able to identify the causes and define the pathological process. In psychiatry, on the other hand, the diagnosis is rarely etiopathogenetic; in most of cases diagnosis is intended as a differential description of several behavioral or emotional syndromes, which are mainly to the purpose of the psychopharmacological prescription. In the end, the word diagnosis can be used in a metaphorical sense; we may speak about economic diagnosis, diagnosis of the causes or characteristics of a social conflict and so on. In this case, the term diagnosis means the "knowledge" about a phenomenon, where the knowledge itself involves descriptive categories of various sciences, e.g., economic, sociological, pedagogical sciences. In psychology, since about thirty years, we have been considering the diagnosis as an act similar to the psychiatric or neuro-psychiatric one. For example, we think of the state exam for enrolling in the registerof professional psychologists, where diagnostic descriptions of clinical cases are often inquired, which refer to the diagnostic and statistical manuals of mental disorders in their various editions, also concerning developing children. In the past, psychology elaborated and proposed its own diagnostic methodology (psychodiagnosis), based on specific psychological criteria and models, realized with psychological diagnostic tools, tests of intelligence or aptitudes, personality tests, motivational tests and others.Psychodiagnostic tools were used, developed in accordance with models and theoretical approaches closely connected with psychological science. In the seventies, the years of protest, this psychodiagnostic practice was deeply criticized and rejected, particularly in our country. After the establishment of university courses in psychology and the assignment of most of lessons to psychiatrists, psychiatric and child neuropsychiatry diagnosis entered psychology. In our opinion, this transition from psychodiagnosis to psychiatric diagnosis has raised many questions: with regard to the intervention on the problems of the relationship and on the relationship between the individual and the context, the psychiatric diagnosis tends, instead, to focus on the "individual" affected by specific mental disorders or particular psychopathologies. The “cure” in all its meanings replaces the psychological intervention, characterizing the professional specificity of the psychologist, leading the psychological profession towards an uncritical acceptance of the medical model. Diagnosis is replacing the analysis of demand. The psychological intervention within the relationship is replaced by the cure of the “diagnosed” individual. We wonder if this diagnostic/psychiatric approach to clinical psychology is useful; as well, we reflection the meaning of this approach in psychology and the consequences of this practice for the clinical psychological intervention. Indeed, according to such an approach, intervention necessarily focuses on the individual and his/her disorders but also neglects and ignores the relationship; a relationship that we can only understand with categories that are different from those of diagnosis, borrowed from psychiatry or child neuropsychiatry.

An example: diagnosis in developing children and psychological function
A medium-sized “comprehensive school institute” can be attended (in the primary, elementary and middle school) by 1,000 children aged between 4 and 12 years.
Well, if we consider the morbidity statistics of the Oppositional Defiant Disorder (ODD) about 200 children with ODD should be present within a school like this. We may add, to these children with ODD, other children affected by:
ADHD (Attention Deficit Hyperactivity Disorder),
autism spectrum disorder,
specific and non-specific learning disorder,
conduct disorder,
developmental disorder,
separation anxiety disorder,
selective mutism,
obsessive-compulsive disorder,
school refusal,
child depression,
eating disorder,
evacuation disorder,
intellectual disability,
specific language disorder,
motor coordination disorder
developmental reading and language disorders ...
but also other disorders that cognitive and child neuropsychiatric diagnostics provide in their diagnostic manuals. We are close to the total number of all children attending that school.

We have probably lost the ”normal” child.
The normal child that we all experienced in childhood. A child with his/her problems, with his/her difficulties, but also with the joy of creative playing, ironic or tragic relationships, with an intense emotionality and an engaging liveliness.
It seems that the attention of teachers, or more generally adults, has shifted from the relationship between people, between children or children and adults, to the individual, to his/her "pathology"; a pathology that "explains" for all relational difficulties. For example, all the problems in the relationship between teachers and pupils, all difficulties in the relationship between parents and children.

Frank Furedi (2003) deals with the tendency to read every social problem as an individual emotional difficulty, as a pathology to be cured, starting from the problematic experience of Americans related to the attack on the Twin Towers of New York in 2001.
The cognitive analysis of behavior seems to underlie the tendency to transform every relational problem into an individual pathology, to be cured or re-educated.
We think that we can identify at the base of this diagnostic trend the difficulty to analyze the problems that teachers, parents and adults generally find in their relationship with children or young people; the difficulty to consider them as relational problems and not as problems that concern the single child or the single boy according to a reductionist vision.

With regard to the issue of diagnosis in clinical psychology, we would like to invite scholars and professionals that work in school and healthcare contexts; colleagues who work with young people, who provide psychotherapy in private practice, who work within the communities or organizations dealing with social marginalization in all its forms. This is an invitation to present useful contributions for deepening a problem that could transform our professional activity into an area populated only by research on and detection of psychopathological behavior, especially regarding young people’s problems.

[1] Furedi, F. (2003).Therapy Culture: Cultivating Vulnerability in an Uncertain Age. Routledge: London.