Does the diagnostic process become simple or does it get complex? Are there multiple measures being taken and multiple perspectives being engaged when arriving at a decision regarding DSM categorization? How important is it to get the diagnosis “right”? What about the managers of the clinic in which the diagnoses are being made? Is accuracy of high priority for them or are levels of production (number of clients being seen) of highest priority?
The level of complexity might reside at the heart of the matter regarding the effective or ineffective use of diagnostic processes. Complexity might also reside at the heart of the matter regarding the accuracy (validity) of the diagnosis. Perhaps a few simple measures will be just as good (or even better) than the biased and often harried diagnoses being delivered by the clinician—and perhaps average people might be able to do as good a job of diagnosing emotional and mental problems and predicting psychotherapy outcomes as high-payed clinicians (Dawes, 2009; Lewis, 2016). The managers of clinics might wish to review these disturbing findings regarding the accuracy of clinical predictions. They might find the solution to the polarizing dilemma they face in choosing between accuracy and productivity.
A few simple criteria for determining treatment strategies and probably outcomes might work just as well as asking clinicians to make their judgment (often using fast thinking, inappropriate heuristics). Unfortunately, the managers might have to look outside their organization for direction in this matter. Government and insurance officials might not have reviewed the outcomes of these same clinical prediction studies. They could still be asking for more elaborate clinical diagnoses (framed in DSM terms) and would feel uncomfortable accepting simpler, but perhaps even more accurate, diagnostic processes.
Assessment
What about assessment? At its core, assessment is about making sense of something. How does this person, group or organization operate? To answer this question, it is critical that the “frog” (person, group. organization) is “alive”—for assessment takes place through observation, examination and gathering of relevant data. A dead frog yields little of importance in any assessment process. While both diagnosis and assessment serve to guide future action, the aim of diagnosis is usually much more limited in terms of scope and duration: it is about guiding the treatment of an individual person or perhaps a small group of people (if the diagnosis is directed toward the functioning of a work team—what is often called “process consultation”).
