Academic journal article Counselor Education and Supervision

Including Diagnostic Training in Counseling Curricula: Implications for Professional Identity Development

Academic journal article Counselor Education and Supervision

Including Diagnostic Training in Counseling Curricula: Implications for Professional Identity Development

Article excerpt

During the last decade, diagnostic training has been increasingly assimilated into counseling curricula; however, the consequences for counselor identity of including this training have seldom been critically examined. The author argues that this diagnostic trend has major implications for the formation of individual counselor identity and for the counseling profession. He discusses associated risks and suggests ways of presenting diagnostic topics.

The last several decades have seen the rise of organized psychiatry, and the accompanying medical model, to a position of dominance in the mental health field (Barney, 1994; Shorter, 1997). The ascendancy of psychiatry is epitomized by the iconic status of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a psychiatric diagnostic system published by the American Psychiatric Association in periodically updated editions that is used by mental health professions from all disciplines, not just psychiatry (Chodoff, 2002).

Coordinators of counselor education programs have responded to the popularity of psychiatric explanatory systems by increasingly assimilating diagnostic training into counseling curricula. Indeed, many counselors have called for the inclusion of diagnostic training in counselor education programs (e.g., Fong, 1993; Furlong & Hayden, 1993; Hohenshil, 1993; Waldo, Brotherton, & Horswill, 1993). This has resulted in changes in the curricular standards advocated by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). Specifically, the 1994 CACREP standards contain only one reference to diagnosis as an important skill to be acquired in the training of mental health counselors (MHCs; CACREP, 1994). The DSM is not even mentioned in the 1994 standards. However, the 2001 standards reiterate the importance of diagnostic training, and not only for MHCs; training in the DSM is mandated as an important requirement for mental health and community counselors (CACREP, 2001). To further illustrate the growing influence of psychiatry on the counseling profession, consider that the name selected for one of the largest branches of the profession is the American Mental Health Counseling Association, language that clearly indicates an identification with the psychiatric health/disease model of emotional suffering.

Surprisingly, there has been little commentary from the counseling profession regarding the potential impact of these curricular changes on the professional identity development of counselors-in-training or on the counseling profession as a whole. The purpose of this article is to suggest some of the effects that this inclusion of diagnostic topics may have on counseling trainees and on the counseling profession. This objective is accomplished by (a) reviewing the rise of biological psychiatry and the response from the counseling profession, (b) summarizing the critiques of the medical model of mental health, and (c) discussing the potential impact on professional identity development of including diagnostic training in counseling curricula.

Rise of Biological Psychiatry and the Response From the Counseling Profession

Historically, psychiatry has been divided between practitioners who advocate a psychosocial orientation and those who have aligned with a biological approach (Shorter, 1997). In the 1950s, powerful new chemical agents were discovered for the treatment of formerly intractable mental disorders. For the first time, effective, reliable medicines were made available for people with mental conditions that formerly would have confined them to an asylum for a lifetime. These advances were instrumental in the rise of a medical model for psychiatry (Shorter, 1997). This medical model was further consolidated in the early 1970s, with the introduction of the DSM. Since the 1970s, and with succeeding editions of the DSM, the medical model has gradually become a dominant force in mental health practice (Barney, 1994). …

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