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Overdiagnosis in counselling?

Citizens regularly receive an invitation to be screened for diseases like breast cancer and cervical cancer. Common sense says getting screened is to right thing to do. Many of us associate screening with reducing the risk of developing symptoms or dying from the disease. Early diagnosis sounds like the safe option. However, is this actually true? In the absence of symptoms, is looking hard for a disease sensible?

Gilbert Welch, Lisa Schwartz and Steven Woloshin are the authors of the book Overdiagnosed, making people sick in the pursuit of health. In their book they address the risk of Overdiagnosis. First and foremost they state: if you have symptoms, go see a doctor! The medical profession has a lot to offer when you’re ill. Subsequently the authors say: if you don’t have any syptoms, think twice before getting screened. You may be at risk of overdiagnosis. Overdiagnosis occurs when individuals are diagnosed with conditions that will never cause symptoms or death. Overdiagnosis is the consequence of the enthusiasm for early diagnoses. It only occurs when a doctor looks for a disease in a person who has no symptoms. The authors explain that for many diseases your chances of being overdiagnosed are much higher than your chances to prevent death as a consequence of early diagnosis and treatment.

The authors describe how the thresholds to determine who has a condition and who doesn’t have changed dramatically over the years. For many diseases you’re diagnosed with that disease much quicker now than before, because the cutoffs have been lowered. As a consequence, many more people get treatment. The risk of overdiagnosis is overtreatment. Being treated for a disease that would never have led to symptoms can be disadvantageous. The treatment may be mentally and physically hard and may cause negative side effects. Overdiagnosis makes healthy people ill.

Might overdiagnosis sometimes be happening in coaching and counselling  as well?

I think hat in the field of mental health, the goalposts have changed over the years too. What was once a ‘normal’ response to a life event has now been ‘problematised/ / categorised.  Let’s ask what might sound a shocking question – might overdiagnosis sometimes be happening in the counselling room as well? Could it be that as a consequence of counselling the client perceives he has more problems than he thought he had when he started counselling? Might it be possible that counselling could, in some cases, actually induce mental health problems? What do you think?

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