Diagnosing in Virginia

STATE SPECIFIC FAQ

Diagnostic testing methods vary depending on the licensure and approach of the assessor. Assessors may use a diagnostic interview or biopsychosocial assessment to arrive at a diagnosis. Some may also use psychometric measures or assessments to support a diagnosis. Art therapists may use art based assessments in conjunction with a diagnostic interview or other methods.
iagnostic testing can assist with self-understanding and decreasing shame or negative thought spirals around internalized messages of laziness, inability to adult, struggling to get life together, etc. I often use the analogy, "Oh, I better understand my operating system." Different operating systems have different capacities throughout the day given a variety of biological and environmental factors. Another analogy: Neurotypicals are like the reputation of Apple when compared to Microsoft Windows. Apple is proven to be arguably more reliable. Undiagnosed neurodivergent individuals are trying to load MacOS on a Windows PC and wondering why it's not working.
Anyone that has used insurance to get services from a provider license listed above has a diagnosis on file. This may or may not have been communicated.
A psychiatric evaluation is typical focused on a diagnostic interview with purposes of medication evaluation and treatment. A psychological evaluation can be provided by various health professionals. The purpose is a diagnostic interview, which may or may not include the use of objectively measured screeners, to determine a psychiatric diagnosis. Both are considered a "psychiatric diagnosis" as the diagnosis is coming from the diagnostic manual published by the American Psychiatric Association.
Licensed professional counselors (LPC) are one of seven mental health professionals licensed to assess and diagnosis in the state of Virginia. The assessment is often called a Biopsychosocial Assessment. A physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner are all qualified to give a psychiatric diagnosis in the state of Virginia. Ethical providers use collaborative diagnosing practices and openly welcome anyone with questions regarding previous diagnoses, including those from themselves. Ethical providers advocate for their clients to support the diagnosis given. Sometimes that requires knowing the state codes for legal, ethical diagnostic procedures. Clients are often forced to jump through unnecessary hoops to "prove" their mental health conditions navigating an invisible hierarchy of credentials, licensure, or a provider's inability to directly communicate to the client they do not feel competent to diagnose a condition. The reason for a referral should always be communicated. Consider the meaning if you do not understand the reason for your referrals.
Medication referrals to treat conditions newly diagnosed in adulthood DO NOT REQUIRE a clinical psychologist to complete a 1-3 hour assessment. Any of the above providers should be assisting with advocating by asserting their legal, medical, ethical ability to provide a psychiatric diagnosis.
Qualification guidelines assign licenses with master's degree requirements the ability to utilize established, or evidenced based, educational and psychological assessments.
An MD psychiatrist, psychiatric nurse practitioner or physician's assistant conduct a psychiatric evaluation, assesses psychiatric disorders, and prescribes appropriate therapeutic modalities and medications. Preferred Providers: clients often report feeling less judgement from psychiatric nurse practitioners and physician's assistants as opposed to MD psychiatrists Ideal Scenario: Collaborative communication across providers beyond simply exchanging records via fax or alternative correspondence.
It helps your provider understand how different areas of your brain are working. It's usually recommended when patients experience change in concentration, reduced organization or decreased memory. Typically 6-8 hours. Sometimes, providers use testing to document your abilities. In-depth evaluation of mental health issues, learning disability, cognitive difficulties or a developmental delay. Preferred Providers: clinical psychologist (PsyD or PhD), neurologist Fact: Designations of neuropsychology or neuropsychologist is not a recognized or protected term in the state of Virginia. Fact: This means certification programs exist for providers to pay companies for the endorsement to call oneself certified in neuroscience therapy approaches or neuropsychology due to the lack of license restrictions. This is not meant to imply lack of credibility to these certifications, but rather that, with everything, you get out of it the amount of effort you put into learning it. Additional certifications are often beneficial for credentialing with insurance and advocacy with navigating invisible hierarchies within the western medical healthcare system.
NAMI: The National Alliance on Mental Illness provides many free resources and will help you figure out how to get your mental health needs addressed if you are feeling stuck or having difficulty navigating the healthcare system. https://www.nami.org/About-Mental-Illness/Treatments/Types-of-Mental-Health-Professionals
In terms of what's considered "science", the field of psychology/psychiatry is a very young field.
The first version of the modern-day diagnostic manual was published in 1952. Time is sometimes weird. For frame of reference, that would be 72 years, just slightly older than my father.
The American Psychiatric Association is responsible for the publication of the DSM. The committee determines how, or if, they would like to use information provided by researchers across the globe regarding these conditions. All providers should be aware of the limitations and biases held within the DSM itself. Not being aware of this contributes to systemic issues and inaccessibility to care.
The current manual is the DSM-5-TR (text revision). This was published in 2013. For frame of reference, when I went to grad school (2006-2008), we were on the DSM-IV. The state licensure did not update the exam to meet DSM-5 standards until 2015. There were MAJOR changes from the DSM-IV to the DSM-5. I still in 2024 see clients come in with diagnoses recently given that are considered "retired" from the diagnostic manual.
Dr. James Davies, PhD (in social and medical anthropology) and qualified psychotherapist, published his findings in the book, Cracked: Why Psychiatry is Doing More Harm than Good. A must-read for anyone frustrated with traditional Western psychiatric care and diagnostic procedures. Not all providers stay up to date with current research to support ethical diagnostic practices.

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