TPC-Journal-V6-Issue2

The Professional Counselor /Volume 6, Issue 2 152 Table 1 Summary of Domains From the Cross-Analysis of the Participants (N = 6) Domain and Category Frequency Insurance influence Diagnosis required for payment of services General Reimbursement likelihood drives the type of diagnosis given General Insufficient assessment time allotted for proper diagnosis General Oppositional defiant disorder diagnostic criteria Criteria are too general General Criteria provide a convenient catch-all for providers General Oppositional defiant disorder is stigmatized African American males Typical Long-term negative implications Typical Assessment, diagnosis and treatment Family, community and other contextual considerations General Mental health counselor bias Typical Cultural and contextual integration Typical Findings suggested that the assessment time allotted by insurance companies to diagnose a mental disorder undermines the diagnostic process and invalidates the diagnosis. One participant empha- sized, “the client is not going to open up to you within that time frame; this is the first time the child is ever seeing you. Those types of things progress over time.” Further structural and systemic assess- ment problems also were identified by another participant: You’re allowed to do one assessment per year for the client . . . The assessor would take the previous assessment, use a majority of that information, and then just ask what has changed between then and now . . . there [are] a lot of questions that the previous assessment didn’t answer or didn’t really look into. So that piece gets missed. Oppositional Defiant Disorder Diagnostic Criteria The DSM-5 criteria for ODD are too general, providing a convenient catch-all for providers. Symp- toms of ODD align with typical child and adolescent behavior as well as other childhood disorders (e.g., ADHD), adjustment disorder, depression and anxiety, depending on developmental context (APA, 2013). Every participant expressed the relative malleability of the ODD criteria. “It’s an easy diagnosis for most people to fit into that category, if they’re having trouble with the legal system and there’s nothing else going on,” noted one participant. Another added that ODD “serves as a holding cell for behaviors that are not understood.” Finally, one mental health counselor stated: There are no differentials for ODD. It’s all under this blurry category of disruptive behaviors. On one hand it looks easy to diagnose, but on the other hand it’s very complicated when you are not ethically doing the right thing.