10 Conclusions

Because the scientific literature generally, and randomised controlled trials specifically, are organised around diagnostic categories, they have to be taken into consideration when counsellors and psychotherapists communicate with third parties. This suggests that the privileging of diagnostic-related groups by health policy analysts, drug company-sponsored medical researchers, government health departments and ‘third sector’ authorities, such as the WHO or APA, maintains the importance and legitimacy of diagnostic categories (despite the range of difficulties with diagnosis we examined earlier). Thus there are pragmatic reasons for considering the role of diagnosis in communication between different groups, despite the many criticisms made of it (Brown, 2005).

This pragmatic obligation to maintain a common language or conceptual framework locks counsellors and psychotherapists strongly into a discourse of diagnosis. This is even the case when mental health professionals in their daily local practice may be mindful of the limitations of a simplistic label for the client before them, with his or her biographical peculiarities. Thus the professional may use diagnosis, as crude shorthand, but then might do their best to understand unique constellations of symptoms in their life context.