Academic journal article Canadian Journal of Counselling and Psychotherapy (Online)

Counsellors Respond to the DSM-IV-TR/Les Conseillers Répondent Au DSM-IV-TR

Academic journal article Canadian Journal of Counselling and Psychotherapy (Online)

Counsellors Respond to the DSM-IV-TR/Les Conseillers Répondent Au DSM-IV-TR

Article excerpt

The conversational work of counselling is inescapably shaped by the other conversations that engage clients and counsellors. At the heart of this work are specific words and ways of talking that counsellors and clients use to make differences in clients' lives. Counselling is somewhat unique as a helping profession for having so many discourses as reflected in its many theoretical approaches. Tensions can emerge over whether the field should move toward an integrated discourse and approach to practice or whether it should stay pluralistic (Cooper & McLeod, 201 0) . The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revised (DSM-IV-TR; American Psychiatric Association, 2000) arguably offers such an integrated language for talking about clients' concerns. Not only is it used by other mental health professionals but its terminology is increasingly known by clients for having been widely circulated by the media.

However, using the DSxM-IV-TR, a symptom discourse, to discuss client concerns can seem at odds with other discourses counsellors use in talking with clients, such as when client concerns are discussed in social justice, or spiritual discourses. Our pluralistic interesr is with counsellors' views of the influence of DSM-IV-TR on their preferred discourses for conversing with clients.

Increasingly, psychiatric discourse from DSM-IV-TR has become the expected norm. In many settings, institutionally, professionally, and culturally, the DSMIV-TR is used to make sense of client concerns (e.g., Watters, 2010). However, in the words of Norwegian psychiatrist and family therapist, Tom Andersen (1996), "Language is not innocent" - particularly diagnostic language that locates client concerns in psychopathologies. To professionally use DSM-IV-TR discourse requires particular kinds of conversations in counselling, in a meaning-making and problem-solving focus that can be at odds with a number of counselling approaches (e.g., feminist, systemic, narrative). In the current research we report here, we surveyed over 100 counsellors and followed up with in-depth interviews with 10 Canadian graduate-trained counsellors (i.e., who would have exposure to the DSM in their training) on potential influences they saw DSM-IV-TR having on their conversational work with clients.

Seen one way, the efforts that will culminate in DSM-V by 2013 amount to a major accomplishment. They will show broad scientific and professional consensus on how to classify and diagnose the symptoms clients present as mental disorders. Clients' concerns become understandable in language familiar to medical as well as counselling professionals. Such a shared language also enables research to occur regarding clients' mental disorders and helps identify the interventions that can succeed in treating such disorders. From the perspective we are taking in this article, the DSM-IV-TR is one socially constructed discourse (Potter, 1996) among others, despite the science that has gone into its construction. However, the DSM-IV-TR is increasingly being taken up as the dominant discourse by administrators of counselling (e.g., Eriksen & Kress, 2005; Linton, Russett, & TalefT, 2008) while the profession continues its pluralistic tradition (Cooper &c McLeod, 2010).

Consensus on what people need to talk about when they come to counsellors has been a source of considerable discourse itself. Discursively speaking, counselling can seem like a Tower of Babel, given its hundreds of approaches, each with a discourse for making sense of and addressing clients' concerns (Miller, Duncan, & Hubble, 1997). In a provocative reflection on a single therapeutic development at a videotaped case conference meeting, psychiatrist and early therapeutic discourse analyst, Albert Scheflen (1978), highlighted very different ways that counsellors described understanding and relating to a clients smile, reflecting their different theoretical approaches. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.