TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 192 In this article, the title DSM will be used to refer to historic versions of the Diagnostic and Statistical Manual of Mental Disorders . References to specific editions will be clearly indicated with numerals or numbers in addition to the title. First, we provide a brief overview of the DSM and its use by counselors. Next, we describe the longstanding multiaxial system and discuss arguments in favor of and against removal of the multiaxial system. Throughout, we discuss implications for counselor diagnosis and practice. Counselors’ Use of the DSM In order to understand the implications of the elimination of the multiaxial system, professional counselors must possess a preliminary understanding of the complex relationship between professional counseling and the DSM . Over time, the more general DSM system has come under critical review, especially by counselors who question how the diagnostic process fits with our professional identity and ethical obligations (Eriksen & Kress, 2006; Kress, Hoffman, & Eriksen, 2010; Zalaquett, Fuerth, Stein, Ivey, & Ivey, 2008). Eriksen and Kress (2005) detailed commonly cited limitations of the DSM and how it is used: • Historically, some diagnostic labels have marginalized, stigmatized and harmed those who are different from the mainstream (e.g., homosexuality was once a DSM diagnosis). • There is limited evidence of cross-cultural validity in diagnostic conceptualizations. • Counselors who focus narrowly on diagnosis may only look for behaviors that fit within a medical or biological understanding of the person’s struggles (i.e., becoming reductionistic). • The DSM system does not include sufficient emphasis on contextual factors (e.g., developmental struggles and transitions, culture, gender), strengths, resources, and uniqueness that may better explain the roots of client struggles and treatment implications. • The DSM system cannot predict treatment outcomes or point to the etiology of mental disorders. • Some people may use diagnosis to accept a self-fulfilling prophecy that their situation is hopeless and that they are sick. • Diagnosing may preclude a focus on the client’s unique construction of his or her experience. • There are flaws in the science behind DSM diagnoses; what is and is not classified as a mental disorder is often rooted in a political agenda and historical influences. Limitations of the DSM require that counselors use it carefully, and thoughtfully consider challenges related to its use. Although Eriksen and Kress (2005) wrote in reference to the DSM-IV-TR, underlying assumptions and broad-based diagnostic processes have not changed in the DSM-5 (APA, 2013). We expect that these limitations will continue to be relevant to counselors. In contrast to the reductionistic, medically oriented diagnostic model inherent within the DSM system (Eriksen & Kress, 2005), counselors emphasize strength-based and developmentally, culturally and contextually sensitive approaches (Kress & Paylo, 2014). Despite the best efforts of many counselors to establish and promote a professional identity that is distinct from other mental health professions, market demands frequently dictate aspects of clinical practice (Eriksen & Kress, 2006). Counselors are licensure-eligible in all 50 states and regularly recognized on insurance panels; as such, there is an expectation that mental health counselors will use the DSM for third-party reimbursement (Kress & Paylo, 2014). Thus, counselors may find themselves working to balance unique professional identities with realities of a diagnostic system created by and for physicians who have a primary focus on pathology. Despite its limitations, the DSM system is useful in a number of ways (APA, 2013; Dailey et al., 2014; Eriksen & Kress, 2005, 2006; Kress & Paylo, 2014). Primarily, it serves as a way of communicating about client problems and struggles. Assuming that all client-related information is considered, it offers a vehicle for