TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 226 individual” (APA, 2013c). The criteria for diagnosis are not listed in the measures but can be found under ODD and conduct disorder in the DSM-5 (APA, 2013g). Although the criteria for both are absent in the measures, APA refers clinicians to the DSM-5, which suggests that the measures completely parallel the diagnostic criteria. The Clinician-Rated Severity of Nonsuicidal Self-Injury (APA, 2013d) is a one-item measure that examines the presence and severity of any nonsuicidal self-injury problems that have happened in the past year. The scale is to be completed based on five levels, including 0 ( none ), 1 ( subthreshold ), 2 ( mild ), 3 ( moderate ), and 4 ( severe ). The item simply states, “Rate the level or severity of the NONSUICIDAL SELF-INJURY problems that are present for this individual” (APA, 2013d). The symptoms are not listed but can be found under nonsuicidal self-injury in the DSM-5 (APA, 2013g, p. 803). Similarly to the previous measures stated, the APA directs clinicians to the DSM-5, which again indicates an alignment to diagnostic criteria. Implications for Counseling Practice The APA (2013g) endorsed dimensional assessment to be used in conjunction with categorical diagnoses. An effort to establish measurement protocols in a process often deemed rather subjective is laudable. The APA indicated that the assessment system was an “emerging” (2013g, p. 729) system, which indicates a rather circumspect decision by the APA. The DSM system represents a system of classifying diagnoses, whose current framework is 20–30 years old and widely established (Jones, 2012). Given the influence of the DSM system of diagnosis (e.g., reimbursement, research studies, treatment planning), the publication of the emerging measures that fail to meet basic standards of testing and measurement could be confusing to counselors expecting that scores of the emerging measures would provide consistent and accurate information about severity and be consistent with diagnostic classifications in the DSM-5 . The presence of validity evidence across the emerging measures is inconsistent, based on erratic reporting of psychometric information and lack of alignment with diagnostic criteria, such as what was documented regarding the disorder-specific severity measures. Although many of the measures were validated for clinical use, other measures lack this information. Perhaps the most basic critique of the system is that the publication of these measures lack alignment with the very diagnostic categories they are supposed to evaluate. Evidence based on test content (AERA et al., 1999) is perhaps the most basic type of evidence for providing validity evidence of measures. The process entails that instruments that are developed be aligned with published research and expert review. Hence, the presence of dimensional measures that are supposed to align with the DSM-5 classification system but fail to be comprehensive in the breadth of symptoms covered could be a serious limitation of these emerging measures. Professional counselors should be cautious in the adoption of the dimensional measures. Many quality measures already exist that adequately align with the categorical diagnostic system of the APA. For example, in the development of the Beck Depression Inventory (BDI)-II, Beck, Steer, and Brown (1996) updated the initial BDI to align with the diagnostic symptoms of depression used in the DSM-IV . The APA should follow similar processes in terms of content alignment and the collection and analysis of data to provide evidence of psychometric properties; counselors must be aware that adherence to this process was not systematically implemented. Both the CCSMs and severity measures were designed to review general symptoms commonly apparent across a broad range of clients and to “be administered both at initial interview and over time to track the patient’s symptom status and response to treatment” (APA, 2013g, p. 733). However, the variability with respect to the diagnostic classifications and absence of psychometric properties limits the potential for these measures to provide accurate and valid assessments.