Toward a Developmental Diagnostic and Statistical Manual: The Vitality of a Contextual Framework
01 Oct 1999-Journal of Counseling and Development (John Wiley & Sons, Ltd)-Vol. 77, Iss: 4, pp 484-490
TL;DR: In this article, the authors endorse an educational and developmental role for counselors, and make recommendations for organizing a comprehensive treatment plan for mental health issues described in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994).
Abstract: Counselors of all types need an understanding of and an ability to work with issues described by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994). The traditional approach to the DSM-IV tends to locate the problem in the client, whereas a developmental approach focuses on the client in social and historical context. Specific recommendations for organizing a comprehensive treatment plan are presented. The authors endorse an educational and developmental role for counselors.
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TL;DR: Six conceptual dimensions that underlie common assumptions about what counts as an adequate category of psychiatric disorder are summarized and the distinction between empirical and nonempirical aspects of classification is reviewed--and it is argued that nonem empirical aspects of Classification are legitimate and necessary.
Abstract: This article summarizes six conceptual dimensions that underlie common assumptions about what counts as an adequate category of psychiatric disorder. These dimensions are 1) causalism-descriptivism, 2) essentialism-nominalism, 3) objectivism-evaluativism, 4) internalism-externalism, 5) entities-agents, and 6) categories-continua. Four different versions of the medical model are described and compared with respect to these dimensions. The medical models vary in several ways, but all can be considered "essentialistic." As a counter to the essentialist homogeneity among the medical models, two nominalist analyses of psychiatric classification are reviewed. In order to fill out the space defined by the conceptual dimensions, two alternatives to medical model approaches are also described. After making some suggestions about where DSM-V might best be aligned with respect to the conceptual dimensions, the authors review the distinction between empirical and nonempirical aspects of classification--and argue that nonempirical aspects of classification are legitimate and necessary.
166 citations
Cites background from "Toward a Developmental Diagnostic a..."
...The same is true for theories that conceptualize psychiatric conditions in the context of normal developmental issues, such as identity and autonomy (48)....
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01 Jan 2008
TL;DR: In this article, the authors present a Dissertation that is protected by copyright and/or related rights, which is brought to you by ScholarWorks@UNO with permission from the rights-holder(s).
Abstract: This Dissertation is protected by copyright and/or related rights. It has been brought to you by ScholarWorks@UNO with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself.
62 citations
Cites background or methods from "Toward a Developmental Diagnostic a..."
...However, the DSM has long been identified by counselors as a medically modeled tool that can hamper the ability of clients to change and grow by assigning them as having an “illness” (Eriksen & Kress, 2005; Ivey & Ivey, 1999; Remley & Herlihy)....
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...Ivey and Ivey (1999), in response to Hinkle, recounted in more detail their experience with DCT and identified a number of points about which they were in agreement, including the need for communication and cooperation with the medical profession....
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...This study was also based on some non-empirical literature (see Eriksen & Kress, 2005; Hansen, 2003; Ivey & Ivey, 1998, 1999; Remley & Herlihy, 2007) in which scholars suggest potential conflicts, advantages, and disadvantages to the counseling profession when learning and utilizing diagnosis…...
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...There is an abundance of literature that addresses the limitations of the DSM as it is applied to counseling and how those limitations are viewed from a developmentally-oriented perspective (e.g., Eriksen & Kress, 2006; Ivey & Ivey, 1999)....
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...For example, Ivey and Ivey (1998, 1999) strongly emphasize counseling techniques that embrace the framing of mental disorders into developmental crises....
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TL;DR: In this paper, the authors describe the conflicts inherent in the DSM diagnostic system with those of the mental health counseling profession and provide clinical practice suggestions for addressing these issues when using the DSM system.
Abstract: Many of the values, assumptions, and philosophies inherent in the DSM diagnostic system conflict with those of the mental health counseling profession.This article describes these conflicts; provides clinical practice suggestions for addressing these issues when using the DSM system; and offers strategies for bridging the divide between mental health counseling's professional identity, and the DSM system of conceptualization.
52 citations
TL;DR: In this article, the authors examine the problematic result of labeling women as "borderline", the subjectivity of BPD criteria; the overlapping comorbidity with BPD and PTSD; and the difficulties created by attempting to fit BPD into the category of trauma disorders.
Abstract: Within the last decade, the diagnosis of borderline personality disorder (BPD) in women has become a fixture in mental health circles (Becker, 2000). It has been suggested that the increase in such BPD diagnoses in women has its genesis in the revisions of the diagnostic code. Specifically, in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) category, the definition of the term borderline has been resculpted to resemble that of the affective disorders, which has resulted in a diffusion of the "border" between psychosis and neurosis from which the disorder is named (Kroll, 1993). BPD is conceptualized to a substantial degree in terms of maladaptive interpersonal behavior. The presence of significant, intense, disharmonious relationships is among the most useful criteria in identifying individuals with BPD (Widigen & Francis, 1989). Research has indicated that individuals with BPD have more hostile representations of significant relationships (Benjamin & Wonderlich, 1994) and seem to have a more insecure attachment style (Sack, Sperling, Fagen, & Foelsh, 1996). Designations of normality and pathology have their origins not only in biological and psychiatric circles but also in sociocultural contexts. The characterization of BPD in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; APA, 1994), reflects a view that the individual experiencing borderline symptoms had a problematic early mother-child relationship resulting in the arrest of healthy boundary development. According to this view, the result is that an individual with BPD has an intense and irrational fear of abandonment, resulting in severe deformation of character. Posttraumatic stress disorder (PTSD), in contrast, is one of only a few diagnoses in the DSM-IV whose symptoms are attributed to situational causes alone. This more favorable language has made PTSD the diagnosis of choice with gender-sensitive counselors, who favor this "non-blaming" label and see it as a means of acknowledging the environmental origins of psychological distress faced primarily by women. Conversely, BPD, which is defined in sweeping language and using broad categories, has acquired a pejorative connotation. The underlying view characterizing an individual placed in one diagnostic category as "disordered" due to a character flaw versus another category that depicts an individual's symptoms as a consequence of circumstances has significant implications both for the counselor and the client. Becker (2000) characterized individuals diagnosed with BPD and PTSD as "bad girl" and "good girl" respectively. In this article, I address issues of whether using the preferred label of PTSD rather than BPD actually holds promise for viewing "borderline" women in a developmental context. I also stress that the pejorative view of the BPD category has resulted in what some have termed a "caste system" of diagnosis and treatment that fails to adequately serve women labeled with BPD. Issues that I examine are the problematic result of labeling women as "borderline"; the subjectivity of BPD criteria; the overlapping comorbidity with BPD and PTSD; and the difficulties created by attempting to fit BPD into the category of trauma disorders. NEBULOUS DIAGNOSTIC CATEGORY The BPD category grew out of the original diagnosis of hysteria, which as a medical diagnosis dates back to the early 1800s. Originally, this term was used when the clinician was unsure of the correct diagnosis, because the client manifested a mixture of neurotic and psychotic symptoms. Many clinicians thought of these clients as being on the border between neurotic and psychotic, and thus the term borderline came into the diagnostic lexicon (Beck & Freeman, 1990). The DSM-IV reports that the lifetime prevalence rates for PTSD range from 1% to 14% (APA, 1994). Sperry and Mosak (1993) noted, "the borderline personality disorder is becoming one of the most common Axis II presentations seen in both the public sector and in private practice" (pp. …
44 citations
TL;DR: The authors describe how they can shift from client diagnosis to case formulation and offer an example of a theory-based etiology and relate case formulation to specific counseling interventions.
Abstract: The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) represents a medical model that can be reframed for more effective use in counseling. To achieve this goal, the authors describe how they can shift from client diagnosis to case formulation. In describing this shift, the authors offer an example of a theory-based etiology and relate case formulation to specific counseling interventions.
40 citations
References
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TL;DR: Rape victims with posttraumatic stress disorder were randomly assigned to one of four conditions: stress inoculation training (SIT), prolonged exposure (PE), supportive counseling (SC), or wait-list control (WL).
Abstract: Rape victims with posttraumatic stress disorder (PTSD; N = 45) were randomly assigned to one of four conditions: stress inoculation training (SIT), prolonged exposure (PE), supportive counseling (SC), or wait-list control (WL). Treatments consisted of nine biweekly 90-min individual sessions conducted by a female therapist. Measures of PTSD symptoms, rape-related distress, general anxiety, and depression were administered at pretreatment, posttreatment, and follow-up (M = 3.5 months posttreatment). All conditions produced improvement on all measures immediately post-treatment and at follow-up. However, SIT produced significantly more improvement on PTSD symptoms than did SC and WL immediately following treatment. At follow-up, PE produced superior outcome on PTSD symptoms. The implications of these findings and direction for treatment and future research are discussed.
1,320 citations
TL;DR: The Association for Multicultural Counseling and Development (AMCD) as mentioned in this paper has provided leadership for the American counseling profession in major sociocultural and sociopolitical domains, through their vision of the centrality of culture and multiculturalism to the counseling profession.
Abstract: For the past 20 years, the Association for Multicultural Counseling and Development (AMCD) has provided leadership for the American counseling profession in major sociocultural and sociopolitical domains. Through our vision of the centrality of culture and multiculturalism to the counseling profession, we have created new directions and paradigms for change. One of our major contributions has been the development of the Multicultural Counseling Competencies (Sue, Arredondo, & McDavis, 1992).
1,058 citations
TL;DR: The efficacy of a brief prevention program (BP) aimed at arresting the development of chronic PTSD was examined with 10 recent female victims of sexual and non-sexual assault who received 4 sessions of a cognitive-behavioral program shortly after the assault.
Abstract: The efficacy of a brief prevention program (BP) aimed at arresting the development of chronic PTSD was examined with 10 recent female victims of sexual and nonsexual assault who received 4 sessions of a cognitive-behavioral program shortly after the assault. Their PTSD and depression severity was compared with that of 10 matched recent female assault victims who received repeated assessments of their trauma-related psychopathology (assessment control; AC). The BP program consisted of education about common reactions to assault and cognitive-behavioral procedures. Two months postassault, victims who received the BP program had significantly less severe PTSD symptoms than victims in the control condition; 10% of the former group met criteria for PTSD versus 70% of the latter group. Five and a half months postassault, victims in the BP group were significantly less depressed than victims in the AC group and had significantly less severe reexperiencing symptoms.
367 citations
TL;DR: Better clinical course of depression was associated with patients who had high levels of social support, who had more active and less avoidant coping styles, who were physically active, and who had fewer comorbid chronic conditions.
Abstract: This article focuses on personal and psychosocial factors to identify those that predict change in functioning and well-being and clinical course of depression in depressed outpatients over time. Data from 604 depressed patients in The Medical Outcomes Study showed improvements in measures of functioning and well-being associated with patients who were employed, drank less alcohol, and had active coping styles. Better clinical course of depression was associated with patients who had high levels of social support, who had more active and less avoidant coping styles, who were physically active, and who had fewer comorbid chronic conditions. Findings provide some guidance as to what can be done to improve depressed patients' levels of physical and mental health and affect the clinical course of depression.
171 citations
TL;DR: In this article, the authors argue that if professional counselors take a developmental approach to a so-called disorder, the positive theoretical and psycho-educational integrity of the American Counseling Association can be maintained while working with the most difficult issues.
Abstract: Professional counselors in educational and mental health settings all must deal with so-called psychopathology. At issue is how can they work with “disorder” from a positive, developmental perspective? Developmental counseling and therapy (DCT) offers an approach to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) classification systems that enables the reframing of severe client distress as a logical response to developmental history. Included are specific suggestions for positive case management and practice. Special attention is given to the interface of multicultural issues, etiology, and treatment. The authors maintain that if professional counselors take a developmental approach to a so-called disorder, the positive theoretical and psychoeducational integrity of the American Counseling Association can be maintained while working with the most difficult issues.
85 citations