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When Clients Reject Your Diagnosis: How to Handle Pushback Without Losing the Therapeutic Alliance

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When Clients Reject Your Diagnosis: How to Handle Pushback Without Losing the Therapeutic Alliance

What do you do when your client doesn’t agree with your diagnosis?

Whether it’s a parent resisting an autism or ADHD diagnosis, a client attached to a different label, or someone overwhelmed by what a diagnosis means for their identity, these moments can feel risky.

In this episode, Curt and Katie break down why clients push back on diagnoses and how to navigate these conversations without damaging the therapeutic relationship,while still doing ethical, effective clinical work.

Transcript

Click here to scroll to the podcast transcript.

(Show notes provided in collaboration with Otter.ai and ChatGPT.)

Key Takeaways for Therapists: Navigating Diagnostic Disagreement

“Diagnosis is only helpful in the benefits of getting some sort of accommodation or clarity and helping with treatment.” – Katie Vernoy

Resistance often comes from stigma, identity shifts, or real-world consequences (insurance, employment, family impact)
Diagnosis can trigger grief, fear, or loss of an imagined future
If a client disagrees, your assessment may not be finished
Avoid arguing – stay curious and collaborative
Focus on function and treatment, not just labels
Use diagnosis as a tool, not a definition of the person
Cultural context matters – diagnosis can both harm and help
Be thoughtful about when and how diagnoses are documented

“Resistance to a diagnosis is not necessarily a symptom of a diagnosis itself. It’s new information that people are learning about themselves. It’s a valid response and handled appropriately can be incredibly impactful in a positive way for a relationship with your clients.” – Curt Widhalm

What This Episode Covers

Why clients (and parents) push back on diagnoses
How stigma, culture, and identity shape reactions
What to do when clients self-diagnose something different
How to talk about diagnosis without harming the alliance
When to hold diagnoses lightly vs. when clarity matters
Navigating insurance, documentation, and real-world consequences

Why This Matters

Diagnosis isn’t the goal; effective treatment and client understanding are.

Handled well, these conversations can actually strengthen the therapeutic relationship and increase client buy-in. Handled poorly, they can lead to rupture, dropout, or harm.

This episode helps you stay grounded, collaborative, and clinically sound when it matters most.

Resources on Diagnosis Conversations

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links.

Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

DSM-5-TR
MTSG episodes on self-diagnosis and diagnostic ethics (see below)

Relevant episodes

Meet the Hosts: Curt Widhalm & Katie Vernoy

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Join the Modern Therapist Community:

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Consultation services with Curt Widhalm or Katie Vernoy:

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Connect with the Modern Therapist Community:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements)

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:13
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is podcast for therapists about the things that go on in our practices, the things that are unique to people in our position. Today, we’re talking about that awkward moment in the room when you pull out that 1000 page door stop that we call the DSM, or you dust off a PDF file that you may or may not have downloaded legally, and you start talking to the client, and the client basically looks at you like you are handing them a cursed object, whether it’s a parent who insists that their child is just spirited, or somebody who is convinced that Tiktok has given them a diagnosis that you can’t find a single shred of evidence for. We are diving into the diagnostic conversation where we want to keep the therapeutic alliance intact, even though our client or their parents might not agree with the diagnosis. So Katie, you and I have both been practicing for a very long time. I tend to work with kids. I tend to run into this kind of a conversation with parents a little bit more since we’ve been doing DBT getting some referrals from some other therapists who might have their suspicions about clients that might present with features of borderline personality disorder. We get this in our practice. You’ve run into this in your practice over the course of your career?

Katie Vernoy 1:52
Of course, I think all of us have had this. I think the nature of my caseload is I’m more likely to have someone that doesn’t agree with more of a delusional disorder, psychosis, that kind of stuff. I don’t have a lot of those on my caseload, but sometimes when those things come up, it’s not necessarily a formal conversation around diagnosis. So it’s a little bit different. It has been. So we can talk about that later. But I think it’s, it’s oftentimes more of those potentially disagreements about what’s causing some of the symptoms, or that kind of stuff. So the conversations might be a little bit less structured than what we’re going to be talking about, but I certainly when I’ve been working with kids and also some of the adults that I’ve worked with, I’ve had some of the similar experience. So I think this is going to be an interesting conversation. I think very helpful, especially because I think for clinicians, some people don’t believe in diagnosis. So we have a whole episode on, you know, self diagnosis, and, you know, kind of what, all kinds of different things about diagnosis. So I’ll put those on the show notes over at mtsgpodcast.com. But I think there’s, there’s this element of, I’ve got an opinion. Maybe this is a diagnosis that isn’t really a fun one to have, so to speak. Not that there’s any, but some of them are a little bit harder to handle, and I have to tell my client, they seem pretty not okay with this type of a diagnosis. And maybe I’ll hurt the relationship. Maybe I’ll say something that feels wrong or unhelpful. And so I think it’ll be a nice conversation to be able to talk through those pieces when maybe the diagnosis is going to be a source of conflict or a little bit controversial.

Curt Widhalm 3:47
So before we dive into the how to talk with clients about this or through that conversation, I think it’s prudent for us to start the conversation with what happens, or the why people might have some resistance to a diagnosis. And this is probably a non exhaustive list, but wanted to at least get into where some of the disagreements might come from. And so talking both from if it’s an individual client that you’re working with, or if you work with children, parents who might disagree with the diagnosis. So the first one on my list is about stigma and shame, and many people fear that some diagnoses are going to be a life sentence. Parents cases, it might be evidence of parenting failures. And a lot of times these stigmas can be either feelings about diagnosis, either just as a family, but it can also be kind of culturally based as well, that certain cultures might look at this as something that is reflective of you know, being a family problem or makes an entire family or lineage lose face. So first and foremost is being able to look at this from a stigma or shame standpoint as at least one of the reasons for why this might be coming up.

Katie Vernoy 5:18
My brain’s going a few different places with that. Sometimes there are consequences. I know that if you get a diagnosis of autism, there’s places that you can’t move to, and there’s there’s other things. So I think there’s also potentially a whole other conversation about what we put into writing and what’s a formal diagnosis versus a non formal diagnosis. But I think that there’s this, this additional piece of identity. What does this mean about me? What does it say about me that I am autistic, or that I have ADHD, or I’m an ADHDer. Or there’s, there’s a whole other kind of area of study them doing around identity versus disability, and so we will leave that there. But I think there’s this, this element of it means I have to understand myself differently, or I have to think about my child differently that doesn’t feel good. Maybe there’s grief and and loss around my idealized self, or my child’s ideal, my idealized child, and so it it’s something where saying, Hey, this is your diagnosis can have so many ripple effects. And even if it’s denial, even if it’s fear, and it’s part of the beginning stages going towards acceptance, I think there’s that element of this can be a really big deal, and it can have huge emotional impacts when somebody is given a diagnosis.

Curt Widhalm 6:50
I’m glad that you’re bringing up the other three things from my list here as well. So just want to tack on a couple of the other fear of consequence. I’ve had discussions, both with clients before, as well as consultations with other therapists about consequences for diagnoses that might end up affecting life insurance premiums, things such as bipolar disorder or anorexia nervosa, being things that when life insurance plan is asking for all of the medical records, that includes ours, and those being higher risk categories that might impact whether or not people can get life insurance or make their premiums go higher. More often, though, with individuals I do hear kind of having to react to the deficit that it might end up creating conversations that it might reduce their entire humanity down to a list of symptoms where it might really impact the way that they see their opportunities in the future. Oh, I can’t do this because of autism, or I can’t do this because of ADHD, so I might as well just give up on doing things altogether, and if this is always going to be there. And to the other point that you brought up, as far as grief and loss, that’s kind of dealing with an internalized grief and loss about what their future is. But that’s often the category that I end up talking with parents about the most is the loss of this ideal future and helping to be able to process through that reaction, to be able to get to some of the stuff that we’re going to talk about a little bit later in the episode.

Katie Vernoy 8:44
One more consequence that I thought about while you were talking was potentially around being able to be employable. I’m thinking about substance abuse or dependence. And switching back now to the grief and loss conversation, there’s also that kind of loss of hope, or the loss of of a sense of who we are, we it’s kind of the veil is lifted. This isn’t just I’m drinking a little extra every day. It’s now there’s a disorder attached to it. And so I think it can be, it can be very challenging, especially if there’s any kind of denial or any whether it’s cultural or just individual framing of it, it can be very hard to get all the pieces together in in somebody’s brain. And so it can feel very like they just can’t get their head around it. It doesn’t make sense. And so I think there’s, there’s a lot there. Are there other things that you were thinking about as far as why folks are really, at least from the from the outset, or from the clinician perspective, not agreeing with a diagnosis.

Curt Widhalm 9:51
The last one on my list is they come in thinking that they have an entirely different diagnosis themselves, and we have a whole other episode where we talk about Tiktok medical school and about the social media self diagnosis trend. We’ll link to that in our show notes over at mtsgpodcast.com. But when there is a disagreement with the diagnosis that you aren’t necessarily seeing the evidence for and some of that is really kind of leading more into trying to help clients find a validation for where their pain points are, where their existence might lie, and really being able to kind of find meaning behind why they are finding a diagnosis themselves that you’re not necessarily able to see through screening stuff. Listen to the other episode. We spend an entire episode navigating through that as well.

Katie Vernoy 10:52
And I want to comment, though, because, and I’m sure I said this in the other episode, but there is a certain amount of self knowing and and we want people to be able to trust their own awareness of their self, of themselves. And I think there’s, as we talked about, some damage that can happen if someone tries to fit a diagnosis onto themselves that does not actually fit. And so just to make sure it’s framed in this episode as well. We are not heavily pro medical model. We’re not anti self knowledge and cultural wisdom. I think it’s it’s something where when there are reasons to have a very official diagnosis, whether it’s the benefits of accommodations, or different treatment options, those kinds of things. We’ll go into that in a second, or if a different diagnosis that’s being held on to is harmful in some way, I think it is important to navigate through this conflict, and so I want to honor a client’s knowledge, and that will be part of the conversation, as we’ll talk about in a second, but that can be an area of conflict, and it has to be handled with care.

… 12:09
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Curt Widhalm 12:10
So when a client disagrees with your diagnosis, there’s some suggestions that I have that a lot of this is stuff that I’ve tried through the past that I think has seemingly helped to navigate through this. You come in with a client and you say, Hey, I believe, based on the assessments that we’ve done, the screening questionnaires that you filled out, you have major depressive disorder, and they respond back with I’m just tired a lot, just losing some interest in everything. I find that arguing with your clients is terrible advice, and you shouldn’t do that. But really being able to lead more with the why of the diagnosis, shifting it from the label to the utility of it, that it might lead to being able to have a more specific treatment plan in order to be able to address their concerns, particularly to the very concerns that they’re bringing in. I mentioned a little bit earlier that we get referrals in our practice for clients that other clinicians might suspect have borderline personality disorder and all of the stigma that goes along with that as a diagnosis, it’s one that a lot of the clients who are not very pronounced in their symptoms, really feel a lot of the shame that we talked about earlier. And so some of the conversations that we might have are also in kind of a working hypothesis sort of way where we kind of shift the conversation a little bit to, well, there are some things that we can deal with that, deal with your particular concerns. You’re talking about how these specific reactions that you’re having are impacting your relationships. So let’s work on the utility of what your presentations are. We don’t have to really focus on just absolutely labeling you with this right now.

Katie Vernoy 14:21
And I think even before that, I feel like it’s important to have a collaborative conversation, because yes, I’m the clinical expert, but they’re the expert of themselves. And so if they’re having an initial pushback, and this is assuming that some of this is new information that comes out because, hey, wait a second. Now, you’ve diagnosed me with major depressive disorder, and I’m saying, Wait, I’m really tired. My instinct isn’t to say, hey, let’s treat it as though it is major depression and see if it works. Although that is a place that I go, the first thing I go to is okay, so where do you think this is exhaustion is coming from? Are there other things we didn’t explore in the diagnostic process? Do we need to get a medical evaluation? Like there’s, there’s things where I don’t immediately go to, let’s, let’s work on it as though it’s if it is true or let’s work on some of the symptoms; I go to, okay, well, it seems like I might have missed something that you feel like would give me more information, and I continue to go until we get to more of a common ground. What is what is it that you’re seeing? And then I go to where you talked about right? Then I go to, okay, so if you’re saying that you’re exhausted all the time, get a medical evaluation. And then let’s see, can we address those things, and see if the psychological elements of it can be addressed. So getting you out of bed every day and a routine and activity, and, you know, whatever it is, right? And and going there. But it seems like some of these diagnoses, like major depressive disorder, if it’s major depressive disorder or adjustment disorder with depressed mood, or, you know, whatever it is, it kind of, unless there’s this more serious symptoms. It kind of doesn’t matter. It doesn’t make a difference. I think it’s more, is it borderline? Is it bipolar? Is it are there psychotic symptoms? Are there? Is there suicidality? There’s those types of things where the bigger labels may be more, I guess, relevant. I don’t even know what the right word is, and so I think for me, it’s, it’s it’s something where, when we’re sitting in kind of that nebulous stuff, and I have a suspicion, but I’m not 100% sure, or they’re very resistant to it, or they don’t agree with it, I may stay in the muck a lot longer of unknowing and and do what you’re saying, but I think I honor, and maybe you’re doing this, but I honor the Okay, this doesn’t sit for you. That makes sense. Let’s talk more about what you think I’m missing, so that I can have more of that context. So then we can, we can get to a place that we both agree on.

Curt Widhalm 16:55
And I realize that I am kind of speaking after the assessment process and what I had mentioned earlier, as far as some of the screenings, but ultimately, what we’re talking about through this is the great benefit of being able to operate with differential diagnoses through your assessment process.

Katie Vernoy 17:16
Well, and I think if a client’s not agreeing with you, I don’t know that the assessment is done. That’s what I’m saying.

Curt Widhalm 17:22
I sometimes run into this with parents where they don’t want further assessment, because it might mean that their child has a diagnosis.

Katie Vernoy 17:31
Yeah, yeah.

Curt Widhalm 17:33
And so you’re very astute in pointing this out, because if we don’t look for it, then it’s not there. But really being able to work with the parents on this is somewhat as as far as externalizing the problem, as far as this is not necessarily a reflection of your parenting if your child ends up having ADHD or ends up having an autism diagnosis, because this is a neurobiological basis, as opposed to just a very willful child who only likes to tie their left shoe and not their right shoe. And is something that a lot of times that conversation ends up being more about what kinds of supports that can end up happening because of the assessment process that it might lead to being able to start a 504 or an IEP at school that helps to be able to deal with a more robust and universal treatment that doesn’t include just outpatient therapy with you.

Katie Vernoy 18:50
Yeah, and I think that’s important. I think that if we if we go in, we feel pretty confident in the diagnosis that we have, we see some utility to formalizing that diagnosis. And there’s pushback, I think, some combination of what we talked about related to further digging into it, doing it more as experimental hypotheses, let’s check this out, and then also really speaking to the utility of having a diagnosis. And for some folks, they might say, Yeah, I don’t want it. I don’t want that on the record. Stop here. And others might say, well, it doesn’t fit for me. I don’t it doesn’t feel right to me. And so I think then continuing to play around in well, let’s help you get to your goals, which may be in their mind, unrelated to diagnosis, and then you can start parsing through. I know when I was working in community mental health, there was some ADHD diagnoses that went away when the trauma was treated. And so I think there’s also some of those things where, where the differential is excruciatingly important, because you could be on the wrong path. And so some of this hypothesis and experimentation is really important.

… 20:06
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Curt Widhalm 20:07
And I do want to go back to something that we both talked about in various ways in this episode, which is particularly for bipoc communities, communities that have been marginalized in the past, is that the very nature of the diagnostic process can bring up around cultural traumas, around the ways that the medical system has been used to over pathologize behaviors. You’ve talked numerous times over the course of our work here on the podcast about the ways that your work in community mental health ended up really highlighting some of this. I’ve seen it. We’ve heard from a number of our colleagues about the ways that the medical system can over pathologize behaviors that are culturally normative. I think that you know the extension of that historical trauma, all of that kind of stuff. But this also really has to make sure that we’re being culturally sensitive through this process as well, that the ways that distress ends up showing up. But also as part of this, when the diagnosis does seem to be very clinically backed up. The assessments are done, the cultural factors have been taken in. Is the intense stigma that can end up happening of both having a mental diagnosis in a community of color that might not just be here’s the diagnosis in and of itself, but also the distancing that can happen from other people in those communities because that diagnosis is there. And so it’s not just the idealized loss of a child or of one’s own future, but sometimes it also means the fear of losing social support systems too.

Katie Vernoy 21:59
I think that’s fair. I think that there’s also an under diagnosing that can happen in communities of color. And so helping a family get to an autism diagnosis versus ODD and conduct, I think, is potentially pretty helpful. And so I think it’s it’s so unique, it’s so individualized to the client, to the family. And I think being able to just really sit with the client, the family, in the conversation, moving towards understanding and acceptance and treatment planning all of that stuff, I think can be very healing. I think it’s when there’s a huge conflict, there’s this issue that we decided before we hit record, that this was going to be a separate conversation, but when parents have political, cultural, religious beliefs that go against a presenting issue or diagnosis like gender dysphoria or other types of social or identity based things that a kid’s bringing out that need to be supported, addressed those types of things. I think that there’s going to be, you know, a whole other set of things. So we’re not talking about that here. We’re honoring that that’s another conversation. But sometimes the kid might agree the parents don’t, the parents might agree the kids don’t. So I think there’s, there’s, there’s family therapy that needs to come in here as well. On how do we understand this, and how do we how do we get to a treatment plan? Because I go back to diagnosis is only helpful in the benefits of getting some sort of accommodation or clarity and helping with treatment. I think the labels themselves sometimes are pretty awful, and even some of the ones that we’re talking about, I think need to be renamed. And so I think saying, hey, let’s get to the diagnosis, and agreeing on the diagnosis is the final end point. You’re not saying that, but I’m saying that’s definitely not what I’m saying.

Curt Widhalm 24:05
So I want to talk about how we talk with clients about this. We’re talking about the ways that this might show up, the ways that some of the reception of the news might be responded to by clients. First and foremost, I think that if you’re really listening to this episode, you’re already running into this, you’re maybe doing a retrospective on some of the conversations that you might have had. We have to acknowledge that we have our own fears about losing a clinical relationship with the clients, that if they absolutely disagree with us that this might mean the loss of a client, somebody who refuses to come back to you. So there are ways to still be able to navigate this and being able to turn this into a real collaborative sort of discussion. And again, not getting into arguments with your clients, but being able to really move from the label into the functional descriptions. And so rather than saying you have autism, you can say your brain seems to have a need for describing functional aspects of their behavior here, or what’s coming to my mind now, isn’t an autism example, but more of an ADHD example of your brain has a high need for stimulation and boring tasks feel painful to you.

Katie Vernoy 25:34
I’m going to say ‘yes, and’ here, I think being able to talk about the whether it’s functional impairments, or the way someone’s brain works, or that kind of stuff as as part of the conversation, I think, is super helpful. I think there’s also the element I want to keep going back to, which is staying open to the fact that you may not be right. Because I think there’s, there’s this element of and this is a fear that I have, and I don’t know that I’ve always been on the right side of this is putting forward a diagnosis that is either discussed too early, is wrong, or whatever it is, can cause harm. And so I think when we, when we take on this task, I think it’s really important that we’re we’re very aware and have a clarity on at least some sense of, at least on how the client is going to respond, how the family is going to respond, what it’s going to mean and how to present it. Because it may be that you don’t start with it’s looking like you have autism. But instead saying, hey, what do you know about neurodivergence? And let’s talk through some of the different things that I’m seeing that that maybe suggests that your brain works a little bit differently, and going through that. Because I think unless someone is ready, and it’s part of the self identified crowd, and they say, okay, good, you’ve, you’ve, you’ve, you know it’s hard to hear, but now you’ve, you’ve reinforced what I already believed about myself. I think that there’s that element of how you present the diagnosis is going to be critical in avoiding some of the things that we’re worried about, which is relationship issues, losing the client or outright harm.

Curt Widhalm 27:32
One of the discussions that we had before we hit record is something that is a whole other podcast to be recorded someday. Conversation which is, do you tell clients what their diagnosis is? Should you tell clients? We’re just acknowledging we’re completely sidestepping that conversation at length here today, but little bit of we’re not completely sidestepping it. Little bit of the discussion is with things such as good faith estimates, with collaborative treatment planning. There’s less and less opportunities to opt out of talking with diagnoses about with clients, and ultimately a good thing. But there, you know, are diagnostic codes on insurance documents that clients will get curious about and Google and then come back to you and say, What does this mean, and why is this getting sent into my insurance? And your response to clients to that particular question can be: Well for the insurance company to pay for our time, I do have to use a code that they will pay for. This code is a billing key. Doesn’t define who you are, as a person or as a you know, representative of a particular community. What this does is this aligns with our discussion, and this is what insurance companies will reimburse for on the treatment that we will address your symptoms with.

Katie Vernoy 29:10
Yes, absolutely. And I think that if there’s a diagnosis that they’re going to see which it sounds like, maybe we can’t avoid that. I think having the conversation at some point earlier in the process makes a lot of sense. You know, getting ahead of it. I think if the diagnosis on the insurance is like adjustment disorder, maybe it’s not as important. And that’s probably already part of the conversation. I think it’s, it’s something where, when the diagnosis is it’s big, and then once we talked about autism, ADHD, bipolar, borderline personality disorder, psychosis, delusional disorder, substance abuse, those types of things, when those diagnoses are in play, having a client see it on a on a piece of paper without any context, is another I think, another way that harm can happen. And so for me, I’m cautious about what I write down sometimes, and I try to diagnose appropriately based on the function of it. But I do think that there are times when being very measured, titrated in how we talk about diagnosis can be a lot easier, because you can change a diagnosis over time. And so if you know someone’s coming in with an adjustment disorder, but you think in the background there might be trauma or that there might be autism, in the background, those types of things, those diagnoses can be fully marinated and and and baked before you put them on paper and have the full conversation with a client.

… 30:52
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Curt Widhalm 30:53
How have you handled some of the conversations around cultural shame when it comes to some of the diagnoses? And while you’re thinking about that, I will say that this is not a universal response that I’ve given, but it’s one that’s been kind of helpful when clients have said, if I have this diagnosis in my culture, this means that I’m crazy or I’m unmarriable and I’m just kind of straight, validated. Yeah, you’re you’re right. There’s a real social stigma that is there, and you’re trying to manage it, and as part of our treatment, let’s talk about how you can get the respect that you need and the treatment that you need while respecting your privacy as best as we can within your community.

Katie Vernoy 31:52
And I think that’s the biggest piece, is that even if someone has a diagnosis, that doesn’t mean that anyone needs to be aware of that diagnosis, but the client or the client’s family. I think it’s, it’s talking about with when the family is aware, when it’s, you know, a kid, and the parents are aware, talking about how to understand it and how to talk about it, when/if to talk about it, what’s relevant. And so I think for me, it’s, it’s trying to sort through, what is the what is the need, and how do we understand it? I think I don’t know that I have more of an answer than that, because I think that that it’s, it’s certainly, my hope is that there’s, there’s a decrease in stigma, and then my hope is that there’s, as generations continue, that there’s not as much of a this makes me unlovable, unmarriable, crazy, whatever it is. I’m hoping that those things shift. But I think I kind of follow along with what you’re talking about. Before we run out of time, there’s one other thing that I do use when I’m trying to help kind of get to a useful conversation with a client, especially the conversations I’ve had is sometimes have been around like delusions or psychosis and that kind of stuff, and helping to get to that space and or there’s two things, actually. One is meeting them where they are. It’s really hard. No one believes you. What you’re talking about, people are not seeing. How are you able to assess what’s happening those types of things and and how do we know? How are we able to identify if this is real or if this is a delusion? And start enforcing, you know, kind of informing and working with them to try to get them to the understanding of what’s happening. I think the other part is, is maybe it’s kind of motivational interviewing, but it’s also helping to look at the symptoms and determine and play some of the same things. It’s like, Well, you said you’re really tired. What does that tiredness seem to be related to? So you’ve been to the doctor, you’ve gone through all those things. What other things could that look like? And so it’s, it’s, it’s really, I guess, helping them go through their own diagnostic process, to be able to get to, oh, this is what it is, and being able to find their own way to the benefits or to the understanding of it. So I wanted to make sure I added that part in.

Curt Widhalm 34:25
Another future episode for us to record is when you’re working with two households, divorced, highly conflicted parents and talking about diagnostics with their kids. A lot of this stuff holds true. My experience is one parent who agrees with the diagnosis, the other parent who is not invested in the diagnosis or invested in the exact opposite of the diagnosis. That’s a whole episode in and of itself. We will record that and get that out in the future at some point. But, to really just kind of take away summary points here that I’m hoping that we walk away with is that resistance to a diagnosis is not necessarily a symptom of a diagnosis itself. It’s new information that people are learning about themselves. It’s a valid response and handled appropriately can be incredibly impactful in a positive way for a relationship with your clients. We do have to consider the stakes of what a diagnosis is for somebody in their social community, somebody in their life insurance, if, now that I’m mentioning court situations, if it’s going to create a paper trail for parents to bring up in divorce court, as far as who’s the most impactful parent for it, and be open to the idea that it’s an ongoing process, and you, even in doing very good clinical work, might find out new information from your clients, it helps you to get to a more accurate diagnosis. So we would love to hear your thoughts on this episode. There’s a number of ways that you can engage with us. Follow us on our social media. Join our Facebook group, the Modern Therapists Group, to continue on with this and other conversations. Follow us on Substack, LinkedIn. Our show notes are over at mtsgpodcast.com and until next time, I’m Curt Widhalm with Katie Vernoy.

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Announcer 36:28
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