DSM-5 Learning Companion for Counselors

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This timely text describes the role of program evaluation in counselor education and provides step-by-step guidance for faculty seeking to develop comprehensive Student Learning Outcome SLO evaluation plans to meet accountability expectations. Du kanske gillar.

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Ladda ned. Spara som favorit. Laddas ned direkt. If you do not know what causes a disorder, how do you know how to treat it?

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It is true that diagnosis is based on symptoms, not causes. That is simply because, in most cases, the specific causes of mental disorders are unknown Dziegielewski, So treatment, including both medications and psychotherapy, is an attempt to address the known symptoms and the unknown causes. It is not always necessary to know the cause of a problem in order to solve it. Psychological treatments have been shown to help people with many mental disorders, even though we do not always know the cause of the disorder Lebow, Should we stop treating people with mental disorders until we know the exact causes of the disorders?

This situation in psychology and counseling is no different from the medical treatment of many physical disorders. Since the cause of many physical disorders is unknown, physicians sometimes simply try different medications, or other treatments, one after the other, hoping one of them will help, and they often do help. Likewise, counselors and psychologists cannot be faulted for trying a new approach after their initial treatment has failed to produce the desired results. Knowing the cause of a mental disorder is not always essential to helping the person who has the condition.

No doubt research will continue, requiring future revisions in the manual as our knowledge of mental disorders increases. The process of determining whether conditions are mental disorders is not based only on scientific research. Diagnoses and their criteria are decided by committees of experts Paris, The committee members are presumed to base their input on scientific research and their clinical wisdom, but, inevitably, opinions get mixed in.

Given the lack of specific biomarkers for mental disorders, as mentioned earlier, some subjectivity is unavoidable, and there is always room for legitimate disagreement about the validity of mental disorders and the criteria used for their diagnosis.

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Criticism: There are several examples of diagnoses being added to or removed from the diagnostic manual based on social pressure from special interest groups and other factors that should not affect the supposedly scientific process of writing the manual. It is true that the inclusion or exclusion of disorders from the manual has been influenced by extraneous factors, and inclusion of a disorder in the manual can have significant social consequences Frances, a. For example, at one time homosexuality was considered a mental disorder.

The change influenced social legislation and cultural norms. The point is that this change was based on a vote of the opinions of psychiatrists rather than on scientific research. There is a lot of debate about whether this disorder is over- diagnosed Frances, a. Of course, to know whether it is over-diagnosed we would have to know the real prevalence of ADHD in the population, but that is extremely difficult to determine.

Nevertheless, the inclusion of ADHD in the manual has resulted in millions of prescriptions for medications to treat it.

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Parents who prefer to refuse medications for their children are free to do so. It is inevitable that the DSM diagnostic system will be influenced by social factors, and that it will have social consequences. It is probably not possible to solve this problem, since every time the manual is changed there are both intentional and unintentional consequences. It could be argued that abolishing the DSM because it has an influence on society would be like throwing the baby out with the bathwater, resulting in chaos regarding the diagnosis of mental disorders, and making it more difficult for clients to obtain needed psychological services.

Criticism: Diagnostic labels are powerful and may hurt people. It is true that diagnostic labels have the potential of being stigmatizing, and efforts should be made to minimize such stigma Byrne, However, diagnostic labeling does not necessarily have a negative effect Ruscio, Some people feel better when their condition is diagnosed. Imagine that you had severe, distressing psychological symptoms and sought help from a counselor or clinician.

It would probably be a big relief to hear that your condition has a name, that you are not the only person who has it, and that there is a treatment that can help. The potential stigma from being diagnosed with a disorder might be outweighed by the positive outcomes resulting from receiving diagnosis and treatment Pies, On the other hand, it is true that labels are powerful and can have negative effects Gray, If someone knew you had a mental disorder, they might treat you differently.

Each individual has to decide whether getting help for a problem is worth the risk that they may receive a diagnosis that could be stigmatizing. One exception would be insurance companies, which require diagnostic codes in order to pay for treatment. Even here, some people have the option to self-pay for their evaluation and treatment, so that the diagnosis would remain confidential.

DSM-5 Learning Companion for Counselors

There is a fair amount of research that suggests that when people who have a mental disorder experience stigma it is not because they have a diagnostic label, but because their behavior appears unusual or bizarre to the people around them Ruscio, The fact that their behavior has a diagnostic label is a small contributor to their stigmatization. Stigmatizing people who have a mental disorder is wrong.

Having a mental disorder should not be any more stigmatizing than having a physical disorder such as diabetes or heart disease. Educating the public about this fact will do more to eliminate stigma that doing away with the diagnosis of mental disorders. Criticism: The pharmaceutical industry has had too much influence on the psychiatrists who work on the DSMs Greenberg, Pharmaceutical companies want more disorders to be added to the DSM so they will make more money selling medications.

It is true that the more disorders there are in the DSM, the more psychiatric medications will probably be sold. Much of the work of psychiatrists involves prescribing medications, which is the most common treatment for mental disorders. As the DSM is revised in future years, policies should be implemented to separate the scientific process of defining mental disorders from the makers of pharmaceutical treatments for mental disorders.

The goal would be to have no conflicts of interest. Criticism: The DSM pathologizes too many people. That seems like a lot of people. This criticism refers to the validity of the existence of the mental disorders described in the DSM If the disorders actually exist, then they should be diagnosed so that people can get treatment for them.

If the disorders do not exist, they should not be in the DSM in the first place.

DSM-5 Learning Companion for Counselors

Only valid disorders those that actually exist according to scientific research should be included in the DSM. But of course, as mentioned above, determining the reality of mental disorders is not yet a strictly objective process. It should also be noted that the list of mental disorders in the DSM-5 includes some conditions that the general public may not realize are mental disorders. For example, insomnia is a mental disorder, sexual dysfunctions are mental disorders, and adjustment disorders are mental disorders American Psychiatric Association, The substance use disorders tobacco, alcohol, caffeine, cannabis, etc.

As evidence that the creators of the DSM do not simply invent new disorders in order to increase business for psychiatrists, consider the fact that many disorders that were suggested for inclusion in DSM-5 were not included. Examples include internet addiction, sex addiction, shopping addiction, and other so-called behavioral addictions, which were not defined as mental disorders in the DSM-5 because the research on these conditions is not sufficient to establish the diagnostic criteria.

Adding so many disorders to the DSM has led to the pathologizing of everyday life. However, counselors and clinicians are not usually in a position to judge the validity of the disorders, although they can access the original research to help them make such a judgment American Psychiatric Association, Counselors and psychologists are typically in the position of using the manual based on the assumption that the disorders are valid. Given the fact that the DSM nosology is widely accepted and no other system has established itself as any more valid than the DSM, clinicians are expected to learn it and use it.

Clients should not be given a diagnosis if their symptoms do not substantially meet the DSM criteria for the disorder. Clinicians should be careful not to over-diagnose or under-diagnose mental disorders. This is, admittedly, not always easy, and honest mistakes will sometimes be made. Only good quality clinical training and experience can help prevent such mistakes. It is true that there is a danger that common human concerns and problems will be defined as mental disorders.

Conditions should only be defined as mental disorders if they meet accepted standards for validity and cause the person significant distress or impairment.

These two factors are currently part of the criteria for almost all mental disorders in the DSM-5 American Psychiatric Association, Criticism: The DSM-5 is based on the medical model, and it assumes that mental disorders are medical disorders. Why should psychologists and counselors use a manual designed mainly by and for psychiatrists? They would like to be able to get payment for providing counseling and psychotherapy to clients who have problems in living, such as marital problems, vocational problems, uncomplicated grief, etc.

Counselors and psychologists who truly believe that the DSM is invalid and harmful to clients should not use it, since doing so would be unethical American Counseling Association, ; American Psychological Association, Of course there would be consequences to opting out of the use of the DSM-5, including being unable to provide treatment to many clients who prefer to pay for their therapy via their health insurance policy. Organizations such as the World Health Organization and third-party payers, including insurance companies, need a standardized system to collect data, and the DSM became that system.

It is highly influential at present, but maybe in the future other, better diagnostic systems will be created and replace the DSM. Until then, psychologists and counselors need to know the DSM and be able to make diagnoses based on it. Most psychologists and counselors probably agree with the psychiatrists that mental disorders do exist and that the manual does a pretty good job of naming and describing them Caplan, ; Ginter, ; McElfresh, They just wish that insurance companies would be more liberal in paying for the treatment of conditions that are not defined as mental disorders, such as marital distress Greenberg, It would be nice if third-party payers would fund counseling and psychotherapy for everyone who wanted it, whether they had a mental disorder or a problem in living.

However, given the lack of financial resources to provide unlimited assistance to everyone for every concern, it is likely that insurance companies will continue to restrict payment to people who need treatment for the more severe conditions designated as mental disorders in the DSM Criticism: The makers of the DSM-5 pretend that the diagnostic manual is much more valid than it really is. Perhaps surprisingly, the developers of the DSM-5 American Psychiatric Association, were careful not to overstate the validity of the disorders described in the manual. However, the last two decades.

The science of mental disorders continues to evolve. The reliability of diagnosis has seen some progress, and research on validity has improved but still has a long way to go Morrison, a, b. This statement is a candid admission that the cause of most mental disorder is unknown. This explains why it is so challenging to establish the validity of mental disorders. In other words, until we know the cause of mental disorders, we will be severely limited in establishing their validity. These cautionary statements should reduce the misuse of the diagnostic criteria, and thus increase reliability.