TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 199 aspects of disability. Similarly, the WHODAS 2.0 only assesses one of four areas of functioning identified by Ro and Clark (2009). Although counselors may find the WHODAS 2.0 helpful for understanding some elements of disability, they may do well to consider additional holistic and comprehensive opportunities to assess client functioning and strengths. Discussion Counselors should be aware that the act of rendering a DSM diagnosis is only one part of a comprehensive assessment. What one reports in terms of diagnosis is just a snapshot of the client. It does not capture the totality of one’s understanding regarding client strengths and limitations, nor does it indicate how counselors go about constructing that understanding. Any thorough assessment must take into account an understanding of all relevant factors. These include, but are not limited to, psychosocial factors such as psychological symptoms, family interactions, developmental factors, contextual factors, functional abilities and longitudinal-historical information. Given elimination of the multiaxial system, we advise counselors to be especially alert to listing V or Z Codes as part of the diagnosis in order to maintain consideration for client context in addition to biology and symptomology. As with prior editions of the DSM , counselors can still use V or Z Codes as sole diagnoses or to augment other diagnoses. Counselors also should document contextual information in their records so that this information can be conveyed to others as appropriate and used to support clients’ treatment. There are a number of models that can be used to guide counselors’ diagnostic, case conceptualization and treatment practices. One such model is the I CAN START model (Kress & Paylo, 2014), which follows: • I (Individual) represents the individual counselor and his or her unique experiences, competencies, limitations and other personal factors; • C (Context) relates to an understanding of the client’s unique context (e.g., culture, gender, sexual orientation, developmental level, religion/spirituality); • A (Assessment and Diagnosis) represents the assessment of the client and his or her symptoms and the accompanying DSM-5 diagnosis; • N (Necessary level of care) refers to the client’s required level of care (e.g., residential treatment, hospitalization, outpatient treatment, individual counseling, family therapy); • S (Strengths) signifies the client’s strengths, resources, and capacities, which can be used in treatment to help him or her overcome his or her problems and thrive; • T (Treatment) represents the utilization of an evidence-based treatment in addressing the presenting disorders or problems; • A (Aims and objectives of treatment) denotes the development of clearly defined problems, with measurable goals and clear behavioral counseling objectives; • R (Research-based interventions) refers to the use of counseling techniques that are based on research; and • T (Therapeutic support services) involves the use of support services that may complement counseling interventions and treatments (e.g., case management, medication management, nutrition counseling, a physical exercise program, parent training, yoga, meditation). The loss of the multiaxial system in the DSM-5 provides both opportunities and challenges to counselors. The exact outcome of how the new process will be implemented is not yet known, and only time will show the extent of its impact. With the loss of the multiaxial system, some of the structure associated with its use is also