TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 276 Examples include autism spectrum disorder and depression resulting from bereavement, respectively. Given these changes, the effect of the DSM-5 on diagnosis may impact clients’ access to mental health services and create ethical dilemmas for counselors related to over- and undertreatment. In addition to the dimensional assessments, the DSM-5 also contains disorders associated with cultural issues. Psychosocial factors are included by using V codes from the World Health Organization’s (WHO) International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ; WHO, 1979) and Z codes from the International Classification of Diseases, Tenth Revision ( ICD-10 ; WHO,1992), as well as three new terms: cultural syndrome, cultural idiom of distress and cultural explanation or perceived cause (Pomeroy & Anderson, 2013). Counselors must become familiar with the ICD-10-CM diagnostic codes, which will become the standard medical coding system in the United States beginning October 1, 2015. Inclusion of psychosocial factors evidences the relationship between psychosocial factors and mental health. Multicultural considerations in diagnosis allow mental health practitioners to understand cultural and individual characteristics that define identity and experience. These characteristics of a client’s identity are multiple and interlocking. The uniqueness that defines a client may be lost if group generalizations as represented by the DSM-5 are used as the only means of understanding a client’s experiences. Critical to understanding clients and their stories is the ability to conceptualize clients as individuals interacting within the sociocultural context in which they live. This also involves hearing clients’ stories from their perspective, using their own words. The importance of cultural influences on mental health diagnosis also is demonstrated by the inclusion of the Cultural Formulation Interview (CFI; Pomeroy & Anderson, 2013). The CFI was developed to improve cross- cultural diagnostic assessment and was created from the Outline for Cultural Formulation (OCF) of the DSM-IV (Aggarwal, Nicasio, DeSilva, Boiler, & Lewis-Fernández, 2013). In keeping with multicultural competency models, the CFI provides a way for counselors to explore and understand clients’ experiences and worldviews, as well as clients’ cultural explanations and interpretations of their concerns. However, Aggarwal et al. (2013) cautioned that the overstandardization of the CFI may result in counselor and client barriers such as the following: a counselor misunderstanding the problem and the problem severity, a lack of conceptual relevance between the client’s concern and counseling interventions, and a counselor and client’s lack of acceptance and unwillingness to engage in the process. Counselors’ ability to develop authentic and caring relationships is essential to accurate diagnosis and relevant counseling interventions. When clients are viewed as unique and counselors understand their experiences, accurate diagnosis and ethical practice are ensured (Swartz-Kulstad & Martin, 1999). Moving beyond an illness model toward a counselor-client collaborative wellness model begins with a process of engaging with the client, gathering the information needed for assessing the client and trusting in the therapeutic alliance to accomplish the goals of treatment (Ivey & Ivey, 1999). Contrary to the medical or illness model, in which the client’s weaknesses or deficiencies precipitate the diagnosis, treatment and policy decisions, the integration of a strength-based framework and counselor preparation ensures a holistic approach to assessment and treatment (Wright & Lopez, 2002). Working with clients from a holistic perspective requires knowledge and skills that preserve the integrity of the counseling profession by embracing multicultural and strength-based considerations. A framework adapted from positive psychology, defined as “the study of . . . what is ‘right’ about people––their positive attributes, psychological assets, and strengths” (Kobau et al., 2011, p. e1), assists in bolstering resilience and promoting mental health. Strength-Based Approaches to Diagnosis Character Strengths and Virtues Character Strengths and Virtues: A Handbook and Classification ( CSV ; Peterson & Seligman, 2004),