This case study illustrates the potential for the application of Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses to exacerbate clients’ symptoms and inhibit the healing process in psychotherapy. Passages are excerpted from therapy sessions to demonstrate that the multiple diagnoses imposed on “Steve” coalesced into his core construct of himself as “crazy.” When his diagnoses became internalized as a construct, his world became viewed through a lens that believed itself to be defective. The use of diagnoses may also have negative consequences for the process of psychotherapy. Alternatives to traditional DSM diagnoses are reviewed. It is proposed that diagnoses should be tentative and rejected if they reify negative self-concepts and do not promote change in clients.
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