TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 242 The Clinician-Rated Dimensions of Psychosis Symptom Severity scale may be repeated at hospital discharge or during subsequent treatment in order to track Saul’s progress. Additionally, Saul’s counselor may find it useful to track his symptoms using the Level 1 Cross-Cutting Symptom Measure. While in the hospital, Saul endorsed sadness on some of the past seven days. If Saul were to respond to an item on the depression domain as mild or greater, the counselor could also use the Level 2 Cross-Cutting Symptom Measure for depression to gather additional information. Saul’s case is unique in that his initial presentation 2 years ago would not have met full criteria for schizophrenia had it occurred after the DSM-5 was released. At the time of his second hospitalization, when the DSM-5 was in use, the additional symptoms made it clear that schizophrenia was the appropriate diagnosis for Saul. Ongoing treatment may help Saul achieve stability and improve his quality of life, and the repeated use of the severity scale may help track his progress. Conclusion These scenarios illustrate which changes from DSM-IV-TR to DSM-5 had an impact on preexisting client diagnoses. Note the core diagnoses did not change, only some of the terminology and specifiers. Why then is it important for counselors to learn about the changes and review existing client diagnoses? Consider the following reasons for careful diagnostic practice. Section E.5 of the ACA Code of Ethics (ACA, 2014) mandates that counselors maintain careful, culturally sensitive diagnostic practices. Section A.2.b further requires counselors to take steps to explain the diagnosis and its implications to their clients. Some clients, particularly those who were previously diagnosed, may not have had the opportunity to discuss the meaning of their diagnosis or its implications with a mental health professional. They may have little knowledge at all or longstanding misconceptions. Some clients, like Martha, may have been first diagnosed by a primary care physician who was not familiar with the DSM and the specific features of depression that it details. The release of the DSM-5 is an opportunity to check in and use counseling and advocacy skills to help clients develop an accurate and healthy understanding of their diagnoses. The cross-cutting symptom measures provide a stimulus to engage in a dialogue about the client’s symptoms and treatment needs. Use of these instruments gathers valuable information and helps clients feel better understood (Clarke, 2013). Counselors can have a tremendous influence on how clients conceptualize their mental health, so taking advantage of this opportunity to shape it in a positive way is a great service to the client. Additionally, converting to DSM-5 criteria and terminology is essential to meet the common language goal that inspired the initial creation of the DSM . Each edition of the DSM has included revisions that changed the criteria or titles used to describe disorders, but instant conversion to the new terms does not happen in practice. For example, manic-depressive disorder became bipolar I disorder in the third revision of the DSM almost 35 years ago (APA, 1980) and yet some people still use the antiquated term today. Attending to the changes and discussing them with colleagues and clients will speed adoption of the new common language. Modeling ethical, careful, current diagnostic practices may have a positive ripple effect on colleagues as well. If counselors, supervisors and counselor educators all use the terms and criteria set forth by DSM-5 , we can more easily communicate within our profession and across treatment teams. In fact, the DSM-5 authors made a special call for all clinicians to use the DSM-5 language as carefully and specifically as possible. For example, authors asked clinicians to avoid using the catchall diagnoses at the end of each section (i.e., not otherwise specified in the DSM-IV-TR , other specified and unspecified in the DSM- 5 ; Phillips, 2013). These diagnoses are sometimes necessary in the short term (as in the case of Bo above),