Academic journal article Journal of Counseling and Development : JCD

Reframing the DSM-IV-TR from a Multicultural/social Justice Perspective

Academic journal article Journal of Counseling and Development : JCD

Reframing the DSM-IV-TR from a Multicultural/social Justice Perspective

Article excerpt

The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) is the most widely used classification system of mental disorders in the United States. The DSM-IV-TR was developed with the intention of assisting mental health professionals to make more informative diagnoses than those derived from earlier versions of the DSM (e.g., 3rd ed., rev.; DSM-III-R; APA, 1987; 4th ed.; DSM-IV; APA, 1994).

Professional counselors are expected to be proficient in using the DSM-IV-TR (APA, 2000) in their work. The American Counseling Association (ACA; 2005) ACA Code of Ethics states that "counselors take special care to provide proper diagnosis of mental disorders" (Standard E.5.a.). The Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2001) Common Core Area 7, which focuses on assessment issues, emphasizes the need for counseling students to learn the principles and methods of assessment and diagnosis of mental and emotional status. Community and mental health counselors are also required to acquire the competencies that will enable them to effectively use the DSM-IV-TR in their professional practices (CACREP, 2001).

Behavioral health care organizations also demand the use of DSM-IV-TR (APA, 2000) diagnosis for treatment approval and payment. In the United States, health insurance companies will typically not pay for counseling and psychotherapy services unless a DSM-IV-TR diagnosis accompanies the insurance claim (Comer, 2007).

Although the DSM-IV-TR (APA, 2000) is widely used in many ways among different mental health professional and health care organizations, it is important to note that this diagnostic nosology represents a medical model that stands in sharp contrast to many counselors' core values and beliefs. The medical model treats counseling concerns and behavioral symptoms as indicators of underlying diseases, emphasizes the client's deficits, leads to a top-down professional attitude, places the client in a passive (recipient) position, emphasizes individual origin of symptoms, and offers medications as the common mode of treatment. The counseling model, in contrast, treats such symptoms as responses to life challenges, emphasizes the client's strengths and assets in dealing with problems, leads to a more egalitarian relationship in the counseling setting, places the client in an active and engaged (agent) position in the treatment process, directs attention to environmental factors that may be linked to the individual's symptoms, and offers nonpsychopharmacological treatments.

Given the differences that exist between the medical model and the counseling helping model in addressing diagnostic issues, and the pervasive impact of the DSM-1V- TR (APA, 2000) in diagnostic procedures and reimbursement policies for mental health services provided, counselors are challenged to consider ways in which they can reframe the DSM-IV- TR to be more consistent with the values, perspectives, and traditions of the counseling profession. In addressing these challenges, we direct attention to the importance of refraining the DSM-IV-TR from an alternative, multicultural/social justice counseling perspective.

There are several reasons for refraining the DSM-IV-TR (APA, 2000) from such a perspective. First, reframing the DSM-IV-TR from a multicultural/social justice perspective reflects an increased awareness of the significant implications that the rapid racial/cultural transformation of the citizenry of the United States is having on the mental health professions. Second, reframing the DSM-IV-TR from this perspective results in more accurate psychological diagnoses. The increased accuracy in such diagnoses occurs as counselors become more knowledgeable of the unique ways that persons from diverse cultural groups construct meaning of mental disorders and the ethnocentric biases that have and continue to be reflected in the DSM-IV-TR. …

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