Growing Better Lives

Diagnosis and Beyond

Diagnosis and Beyond2

Growing Better Lives offers a clinical consultancy service for individuals who would like an independent psychiatric opinion about their diagnosis. Our area of special expertise is longstanding and complex emotional disorders, which often attract labels such as ‘personality disorder’, ‘complex trauma’, ‘PTSD’, ‘emotional intensity’ or ‘borderline’.

We do this for individuals who are unhappy with the diagnosis and treatment they are receiving, for hospitals who want a ‘second opinion’ or ‘single joint expert clinical review’, and for health service commissioners who want help to decide what to do when no suitable local services are available. We are not willing to undertake the assessments unless the person concerned wants it themselves, and can give fully informed consent.

A ‘diagnostic formulation’ is the term we use for the report we prepare. It is a psychiatric diagnosis together with a psychotherapeutic understanding of the whole range of factors that led somebody to be in the state they are in. Recommendations for further therapy and treatment are included.

Diagnosis (using the DSM-5 or ICD-10 systems of psychiatric diagnosis) by itself is of limited clinical use in cases of psychological complexity; formulation by itself (as usually undertaken by psychologists or psychotherapists) lacks the psychiatric rigour needed for an authoritative medical opinion. Our ‘diagnostic formulation’ combines the two in a flexible way that allows the person concerned to be at the centre of the process.

We undertake the assessments by two of us from the Diagnosis and Beyond team holding a long interview with the individual, in a location of their choosing. One of our team is a medical psychotherapist (a psychiatrist trained as a specialist in psychotherapy, normally Dr Rex Haigh), and the other is an ‘expert by experience’. This is somebody who has been through severe mental health problems and successful treatment her or himself.

The three of us have a detailed conversation about the problems experienced, the treatments tried and how they have helped or not, the family of origin, and important life events. We also use structured questionnaires, and explain the results of them. We involve families, other professionals, and formal case records as much or little as needed: the core information we are interested in is not what other professionals or anybody else thinks, but the experience of the person concerned and his or her relationships – past and present, personal and professional.

When we have gathered all that information, which usually takes between one and two hours, we ‘pull it all together’ to make sense of it – in a way that we all agree the main points of the ‘diagnostic formulation’. We also discuss the different sorts of further treatment and therapy that might help. The most important aspect of our process is its ‘co-construction’ – the way we only come to conclusions through a process of detailed discussion, shared understanding and mutual agreement.

This is then all written up as a fairly short report, which can used as required. If it is to be used by anybody apart from the individual concerned, the person it is about must give written permission.

If you want more information about this, please click on the button below and complete the information request form  Info request: Diagnosis & Beyond