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A mailed questionnaire was used to investigate Certified Clinical Mental Health Counselors' use and opinions of the Diagnostic and Statistical Manual of Mental Disorders (Third Edition, Revised) (DSM-III-R). Data collected for the study indicate that respondents use the diagnostic system for billing insurance, case conceptualization, treatment planning, communication with other professionals, meeting requirements of employers and external entities such as courts, and educational and evaluative functions Disadvantages of using the system cited by respondents included possible negative results of its use, bias and labeling, difficulty in usage, and difficulty applying the DSM in marriage and family counseling. Findings of the study also indicated that respondents believe clients are deliberately misdiagnosed using the system.
The Diagnostic and Statistical Manuals of Mental Disorders (DSMs; American Psychiatric Association, 1952, 1968, 1980, 1987, 1994a) are among the most important diagnostic documents in the history of clinical counseling, psychology, psychiatry, and social work. The original document, DSM-I (APA, 1952), and its four revisions are best viewed as evolutionary documents that have been periodically revised to reflect new research in mental health. The DSM-I was introduced some 40 years ago with revisions being published in 1968 (DSM-II), 1980 (DSM-III), 1987 (DSM-III-R), and 1994a (DSM-IV). In each instance, the number of diagnostic categories was increased, more comprehensive descriptions of diagnostic criteria were provided, and efforts were made to increase clarity. With increased reliability of clinical diagnosis in each revision, the DSMs have facilitated treatment and research (Hohenshil, 1992).
If used properly, the DSM system is an important clinical counseling tool for several reasons. First, it provides a common language which facilitates communication among mental health specialists for the purposes of treatment and research (Jampala, Zimmerman, Sierles, & Taylor, 1992; Velamoor, Waring, Fisman, Cernovsky, & Brownstone, 1989; Williams, Spitzer, & Skodol, 1986). Second, as the most widely used system for the diagnosis of mental disorders in this country, it provides a system for diagnosis of mental disorders which is used by insurance companies for thirdparty payments, by various government agencies for accounting purposes, and by mental health professionals practicing in agencies, private practice, and hospitals (Mead, Hohenshil, & Brown, 1994). Third, the DSM enhances the selection of effective treatment procedures as it is now possible to identify treatment approaches most likely to...