Don’t Expect a Diagnosis


If you are looking for a diagnosis of “Major Depression”, this is the job of a Psychologist (a therapist who has registered as a Psychologist after obtaining a PhD in the field) or Psychiatrist (a Medical Doctor who has done further training in Psychology).

Though we therapists will likely notice patterns organizing around a diagnosis if we have been trained well, Clinical Counsellors do not have the pressure on them to diagnose. This for perfect for me as I have never been wildly interested in the Diagnostics Statistics Manual (DSM), except through the lens of Depth Psychology which sees it as a book detailing the neuroses of our time.

The DSM can come in handy for providing a language and framework for professionals and clients to communicate around the extremes and particular organizations of behaviour and coping mechanisms. However, a diagnosis is a description and it is also very much a reflection of current cultural beliefs and norms. After all, it was in 1973 that Homosexuality was finally removed from the DSM as a pathological diagnosis.

In the view of Depth Psychology, we look at the DSM as quite unhelpful, and even dangerous, when it is tied to the assumption that this person’s tendencies, beliefs and behaviours happen in a vacuum apart from the culture we are living in and have grown up in within our family home. However, it can be highly enlightening when we each examine the ways in which we fall into some of these patterns and dig deep as to how any one of them may constellate in us in painful times. It was one of the founding fathers of western psychotherapy, Alfred Adler, who said: “The only normal people are the ones you don’t know very well.”

Neuroscientist, Dr.Dan Siegel, speaks about every disorder essentially being an example of chaos or rigidity within an individual’s nervous system and brain development (sometimes at a very young age) in response to unfavourable circumstances, or trauma. When I took his course in 2009 at the Adlerian Conference in Victoria, BC, I was thrilled to hear this description, which matched my felt sense too.

You may also be familiar with Gabor Mate’s explanation of personality disorders being evidence of insecure attachment.

So, the work I do is very different from what you may expect if you are used to treatment through the medical model. In focusing, we actually put the label on the shelf and see if we can get to the core of what is bothering you. This can be challenging work if we strongly identify with the label we have been given, and it feels scary to be without it, but just having an hour of time just for you to actually be with what is inside you is the therapy work, in my opinion. There is nothing to change. And if there is, change happens naturally when we truly witness what is alive in us right here and now.


Angela Cara

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“Circlework provided for me a space to reflect and feel connected to myself and other women. To be able to take that feeling—that space—with me day to day provided me with a sense of empowerment and reassurance to any challenges I may face.”