Do You Need a Diagnosis to Start Therapy? A Psychodynamic Perspective

A question I hear often, sometimes directly, sometimes more implicitly, is: "Do I need a diagnosis to start therapy?". In short, the answer is no...

For many people, the idea of therapy is tangled up with labels, assessments, and referrals. Some arrive, particularly in NHS settings, with a handful of diagnoses. For those coming to private therapy, there’s often a worry that unless something is "officially wrong," you’re not eligible, to seek help.

Where the Question Comes From

There are many understandable reasons why this question arises. Let's address some of these (from a UK perspective):

• NHS systems often require a diagnosis to access mental health services or specific kinds of support. This is driven by a medicalised model of mental health that is ubiquitous across the NHS. In a way, it’s understandable: we need some way of categorising issues in order to help people. Where it becomes unhelpful is when people start to believe they have a "broken brain" or that there is something concretely wrong with them. When we speak in medical language, this slippage is almost inevitable.

  
  

• Online mental health content is everywhere, offering checklists for everything from ADHD to CPTSD to autism. There has been an explosion of influencers and online trends around diagnosis and self-help. Some of this is good, particularly peer-support spaces. However, some of it is less helpful where you can find a culture of grifting influencers with questionable qualifications, throwing diagnostic language around. While self-diagnosis can sometimes locate a need for assistance, it can also pathologise ordinary human struggles or externalise internal emotional life in a way that obstructs reflection.

  
  

• Diagnosis offers a sense of clarity: Perhaps for some there might be a feeling that if it can be labelled it can be fixed. That maybe someone will take something seriously if these feelings have a name. As a start of things, a diagnosis can help if there has been a total denial of suffering and the loneliness and alienation that this can bring. With this it can bring relief, structure, and recognition. It can be especially helpful if someone has felt unseen, unheard, or abnormal. Ironically, it can also help to feel a sense of normalisation, to know there’s a name for a certain pattern of feelings or symptoms.

This being said a diagnosis necessarily encourages the location of the issue outside of ourselves, as if it's something discrete and separate, a thing inside but apart from us. While for some it might be a helpful first step in allowing people not to feel so alone or disconnected, it should be the beginning, rather than the end, of the enquiry. The trouble is a diagnosis can risk detaching and foreclosing important questions for the person.

From my perspective we do not want things to impinge on someone's curiosity about themselves or their suffering. Curiosity is the motor for change.

You can come for therapy even if you don’t yet have the words. You can come with questions not answers.

The Psychodynamic & Psychoanalytic View

Psychodynamic therapy isn't interested only in symptoms but in stories, how our emotional life has unfolded, how past experiences continue to shape the present. The stories we tell ourselves unconsciously, narratives that haven’t yet been put into words.

With a desire for a diagnosis someone might rather be expressing a need to make sense of certain feelings or behaviours, and hoping that a diagnosis could provide that clarity.

Alternatively some people come to therapy with a pile of diagnoses, bewildered and confused by them. Others bring questions about whether they might meet the criteria for something. I'm not suggesting these are things to ignore, however, deeper work lies underneath. In grief, guilt, shame, fear, longing, or anger. Emotional experiences that, repeat, or arrive unexpectedly, or lurk in the background colouring our worlds. We might find that many of these feelings began years ago, that these are things that need more than a simple label, but rather present a need to be felt and understood. In part, this is the task of psychotherapy.

A diagnosis might tell us what’s happening but therapy helps us understand why.

Diagnosis can prevent access to care in health systems, and it can stigmatise individuals. In private psychodynamic therapy, you don’t need a diagnosis to start. People come for all sorts of reasons:

• You might feel something inside doesn’t feel quite right

• You notice you keep repeating the same patterns

• You’re feeling overwhelmed, numb, irritable, or exhausted

• You’re feeling low, anxious, or worried

• You feel that something about your relationships isn’t working

  
  

You can come even if you don’t yet have the words, with questions in feelings.

If you're feeling unsure, you might find this helpful: Common Myths About Starting Therapy

When Diagnosis Is Helpful...

That said, diagnoses do have a place and can be helpful.

They can provide access to services, though this is also a problem with systems... They can help you feel seen and more normal, especially if your experience has been minimised. They can offer clarity, particularly during a crisis. A psychodynamic therapist won’t ignore a diagnosis, but they might be curious about what it means to you. Does it feel like a relief, a burden, a box or a life raft? Importantly, there might be interest behind the diagnosis.

What’s Really Being Asked: Do I Need a Diagnosis to Start Therapy?

When someone asks, "Do I need a diagnosis to get therapy?", they might be asking a host of other less formulated questions such as "Am I allowed to feel what I feel?" or "Is my pain real, even if I can’t name it?" Or they might be wondering, "Can I be seen without needing to be classified?"

These are speculations, of course, we can't know the answer to what drives anyone's desire without a deep and collaborative enquiry with the person in front of us. Though coming to know this might be part of a therapeutic process: exploring the internal dynamics, both conscious and unconscious, that might be driving concerns.

Importantly, though, therapy shouldn't be about fitting you into a box. It’s about understanding the boxes you think you're in, the ones you’ve been placed in by others, and the ones you keep placing yourself inside. It’s about making space for your experience, especially the parts that don’t feel like they fit anywhere else yet.

Thinking About Starting Therapy?

If you're curious about therapy, with or without a diagnosis, you're welcome to get in touch. I offer psychodynamic sessions in Hackney, London, and online. No diagnosis required.

About the Author

I'm a senior NHS psychotherapist with a private practice in East London. I am a member of the British Psychoanalytic Council (BPC) and abide by their codes of ethics.