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It probably depends largely on the country you live in, and it likely depends on the organization or psychologist who assesses you. I can also imagine your age is going to be relevant in how long it takes to get to a diagnosis.If I remember correctly it took about three months in my case, though the appointments were somewhat sporadic. I first went to the doctor for a referral, but my doctor at the time was in a different city from where I lived, so all she could do was recommend me to make contact with an ‘expertise center’ for autism in my city.I made contact, I was put on a waiting list, and I believe a month later I had my first appointment. Over a time span of weeks I talked with a psychologist, and on two occasions I had to fill in psychological tests taking up to two hours. At one point I was also given forms for my mother to fill in, which was predominantly information of my early development. They recommended the mother to fill in this information based on the premise that she would have payed more attention to my early development, but in principle either or both parents could fill in the information.Eventually I had a talk with a head clinical psychologist, who did a few tests. I remember he showed me an elaborate illustration from some vacation resort, which could have been from a children’s book. He said, “Describe what you see here”. It took me a few minutes to describe all that I saw, which included people swimming, people on a boat, people drinking, people playing badminton, people sunbathing, children running around etc. Like I said, it was a really elaborate illustration. Turns out that most neurotypicals would have said “a vacation resort”, whereas I took my time to describe all the details.So all in all, it took about three months for me, but in principle it could have been done within a week. It would have been an intense week however, so I’m glad they distributed the appointments over a longer time period.For more information on (high-functioning) ASD, have a look at: Embrace ASDA blog about quantitative- and qualitative research on autism, by Natalie Engelbrecht and Martin Silvertant.

Yes, it definitely does happen. You need to get whatever proof you can of cause and effect in writing.Currently there are some big loopholes in the law that allow medical professionals to get away with blacklisting patients.There are dog-whistle terms routinely written in patients’ medical records that are designed to repel potential doctors from taking a patient and designed to erode the current doctor/patient relationships with a patient’s current treating professionals (and for the most part all doctors know what those coded terms are).Conspiracy? Well, it is and it isn’t. The best way I can describe it is that it’s most closely like institutional racism (except rather than discrimination based on race it is against patients as a class). “Institutional” refers to the idea that a certain belief or dogma is generally socially accepted within an entire system.Therefore, if the majority within that system holds certain beliefs such as “when a patient does this they must be drug-seeking”, or “Patients who want to have the last word in treatment decisions are non-compliant” they act accordingly as though there is a generally accepted way to assess a situation and differentiate what they see as “bad patients” from “good patients.”There is already a culture of bullying that doctors themselves are subjected to from medical school, through residency, and then this is unconsciously brought into practice and often taken out on patients (the patient being low man on the totem pole).In addition there is a “sacred cow” factor placed upon doctors, especially in the US, and in many circles cruelty and bullying when it comes from a doctor is overlooked, and too often excused.So powerful is the image in people’s minds of the doctor as “benevolent healer” that many, even in regulatory positions have a hard time wrapping their head around the concept that a doctor can be “dirty” just as a cop can. Often the corporations that employ them are dirty as well.Although it may not start out that way doctor and employer end up in bed together and soon there is considerable pressure for them to close ranks; two against one, and in order for both to save face (and in some instances even to avoid being sued) one hand washes the other.On a psychological level many people don’t want to believe this goes on because it’s just too scary to fathom, so they push it away and just don’t deal with it, but that won’t make the reality of it go away. I guess you could call that a “conspiracy of silence” although it may not be a conspiracy in the classic sense of the word that all participants have a common motive, nor that it is entirely intentional and conscious on everybody’s part.That’s how biases work. They tend to be kind of infectious. People often don’t even realize there’s a problem or that their quickness to dismiss a patient or his/her concerns is a bias.Within an insular system such as a healthcare corporation the very system that is supposed to cooperate to benefit the patient can suddenly and with little warning become a breeding ground for a hostile environment.It’s second-nature for people to choose sides and for tribalism to take over in any workplace. That’s exactly what makes it so dangerous; because many working in such environments don’t even understand the injustice being perpetrated right in front of them, and so they play right into the hands of those few who might actually be committing intentional acts or omissions.Before you know it the chart of a patient is unfairly stacked with lies; those of the originator and then multiple doctors repeating those lies.Let’s say, for instance then the patient goes to a specialist. That specialist requests the patients’ records which by this time make it appear that everyone is on the same page and think this patient “must” have done something wrong, and the new doctor is quite alarmed at all of this and it has the effect of making him come in with doubt about the patient right from the beginning.He does one of two things (usually).Backs out and declines the referralTakes the referral but with serious reservations and from that point on is quite likely to start the doctor/patient relationship off looking for “red flags” that this patient is hell on wheels such as what he’s read in their medical record. The relationship then will probably always be guarded, at best and real trust will never really be possible.If a doctor is probably in the 1% that thinks outside the box and truly forms his own opinions even at the expense of scorn by his colleagues and employer he/she might decide to disregard all the BS in the chart and see it for what it is; gossip and heresay, then set about testing and treating the patient for the condition/symptoms he/she came in for.Quite honestly most doctors working in today’s field of medicine are not looking for a challenge, they’re looking for “easy” or “simple”.With high caseloads, and autoimmune diseases at epidemic proportions many of which are anything but simple, many doctors don’t want to put in the time and effort it requires to give the patient the care they need. When they think about that these diseases are generally incurable, life-long conditions with no easy answers they are anything but energized and intrtigued (even if it in fact should be viewed as an important learning experience). I’m pretty sure any doctors reading will know the answer to the question I’m about to pose before I even answer it.What is the easiest, and quickest way to get out of treating a patient whose condition you feel too complex and more work and expense than you feel the outcome/prognosis will justify?????For those who don’t alreay know the answer; I’ll tell you;The easiest way not to have to treat that patient and get yourself off the hook is to suggest that they’re not sick at all; either that they’re faking it, or that their condition is “functional”, (in layman’s terms they believe mistakenly, even delusionally, that they’re ill when in fact it is a psychological, not physical, problem).If in a doctor’s “professional opinion” that patient isn’t really sick then it would follow that there’s nothing to treat, thus they will not be in any trouble for malpractice should the patient or family bring suit later. All doctors know this little trick.Sometimes they are well aware that this assessment is untrue and that the patient is legitimately ill but figure that either some other doctor will eventually discover it and they’ll be long gone by then, that no doctor will look that deeply because they’ve already set the stage for the patient not to be believed, and either way they’ll be in the clear when that happens.In other instances it’s less clear-cut than that and it may be more a lack of adequate training or critical thinking about what other tests to run when the initial tests are not immediately diagnostic.Sometimes’s it’s just shoddy workmanship and doctors may overlook or dismiss test results that in fact do mean something indicating a diagnosis or at least giving them direction on what to look for next.Their training has taught them that this is an “acceptable” way to view and behave accordingly toward a patient, and there is a certain amount of lying to themselves that this is morally alright even when the patient sitting in their office is visibly suffering. That needs to change, and instead the focus should be placed on more research for these serious and difficult-to-diagnose/difficult-to-treat diseases. Throwing the patient under the bus should never be considered an acceptable option even when there are no easy solutions.Efforts are currently in the works to enact legislation to better protect patients from blacklisting.A number of patients have created a petition which goes to US Congress, Health and Human Services Secretary Sylvia Burwell asking that more iron-clad and specific protections be afforded patients who find themselves without fair recourse because of this and other such loopholes and/or regulators’ rather lack luster enforcement regarding this systemic patient abuse.You can sign and add your personal experiences with this type of atrocity here → Sign the Petition

Are there clients that I worry about outside of sessions?When therapy is going well, I do not think about most clients until just before their next session. I have enough experience and knowledge by now that I trust I will know what to do. However, there are a number of situations that concern me and I do think about these clients and how best to meet their needs:New ClientsThe first session is usually the hardest. We are strangers to each other. In some cases it is very clear to me what needs to be done and I have confidence that the client and I can successfully work together.Lack of Clarity: In other cases, it may not be at all clear what is really going on. The client may present in a vague and confused way. It will take at least a few sessions to form and test hypotheses about the client’s issues and formulate a plan. I may think about this person’s situation from different angles between sessions. I usually get a handle on it in a few sessions and then I stop thinking about the client as much. If all goes well, I am back to my usual pattern of just thinking in session.Level of Mental Illness: Now that people contact me over the internet, often without being referred by their physician or anyone else I know, they may have issues that I am not trained to deal with or do not usually treat. Before, the referral source was a fairly good predictor that the client would have issues for which my skills are a good fit.Regular therapy for standard problems or personality disorders is relatively easy for me, but some people show up who I quickly discover have more severe issues. They worry me. I have to rather quickly assess whether I should refer them out or do at least a few sessions as a trial.Whatever I choose, I will still worry a bit about them after they leave. It is very sad for me to meet people who I may not be able to help. I worry about the quality of their lives. I am still thinking about a deeply troubled man I saw two years ago.Forming a Working Alliance: I also have to find a way to bond with each client and make sure we become equal partners moving forward together for their benefit. With some clients this is easy. For example, moderate to high functioning Borderline clients are usually warm and are not too damaged or conflicted to form attachments. I usually do not have to work too hard to win their trust. I do not worry about them between sessions.Bitter and Paranoid: At the other extreme are clients who are bitter and paranoid. Often they are what I think of as “failed Narcissists.” They have a vast sense of entitlement, but success has eluded them because they are struggling to function normally.They compare themselves to extremely successful people and insist that they deserve the same degree of success because they see themselves as just as smart and capable as the average billionaire. Then they look at their own life and feel like failures. They reason that somehow they have been cheated out of the success they deserve.I have to be extra careful not to say or do anything that contradicts their belief because this rationalization is their psychological lifeboat and without it they may decompensate and become even less functional.I do think about this type of client between sessions. I want to help, but I there is no simple path out of their dilemma. It is a very delicate situation with a very fragile client. A misstep on my part might make things worse.Often there are multiple issues, some more serious than others, and I have to help the client prioritize them because we cannot work on all of them at once.Suicidal: Whenever a client brings up suicide, I have to take it seriously and explore the possibility with them. I have to assess how serious they are. Are they just blowing off steam? Are they serious? Are they simply asking for my attention in a dramatic way?Until I am satisfied that there is no real danger, I am concerned—and my concern does not end when the session is over.Therapy Failures: Even when I terminate a client because they are unwilling to take their therapy seriously, I may still wonder: “How are they doing? Did they ever get the right therapy? Did their ex agree to take them back? Did they get over their depression?”I was working with a man that I terminated with twice (he literally begged for a second chance). In therapy he lied, whined, refused to do anything to help himself. I knew it was pointless and very frustrating for me to keep seeing him, so I ended the therapy. But…I still think about him and hope something good happened for him. I do not want to be his therapist, but I still am concerned for him.Longterm Clients: There are some clients who like being in therapy and stay for a long time. Some leave because money or time become tight—or they wanted to explore how they would do without therapy. Most, by the time the leave therapy, are coping with life better and have explored and solved the majority of their life problems. I think of them fondly from time to time. But, a few regress. Without me in their life, they start to emotionally lose ground. This is disappointing. I usually end up mentally revisiting my work with them to try and learn from this situation.Dead Clients: I have had three or four clients die while they were in therapy. A few were extraordinarily brave and they were facing an incurable disease. But some deaths are unexpected and shocking. This past year, a longterm client who I liked a great deal and who had overcome most of her psychological issues died suddenly, the day after a therapy session. I miss her. She was a good person.Punchline: When a client’s therapy is going well, I do not usually think about the person between sessions. When there are therapy problems I need to solve, I am more likely to be thinking about the best way to proceed. I certainly do not think about all my clients between sessions. However, while there are some clients I do not think about after they leave therapy, there are others I never forget. They still come to mind and I wonder about how they are doing.A2AElinor Greenberg, PhD, CGPIn private practice in NYC and the author of the book: Borderline, Narcissistic, and Schizoid Adaptations.www.elinorgreenberg.com