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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.
The influence of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR; American Psychiatric Association, 2000) assessment system on the mental health field has been profound. In fact, it is difficult to overstate the magnitude of the DSM's presence in the mental health profession (Eriksen & Kress, 2005; Hinkle, 1999; Seligman, Walker, & Rosenhan, 2001; throughout this article "DSM" will be used to refer to the system of diagnosis described in the various editions of the Diagnostic and Statistical Manual). The DSM's multiaxial assessment system has become the primary language of communication regarding client problems, offering a way of reducing complex client-related information into a manageable form (Seligman et al., 2001). Also, the DSM, by categorizing people's psychological problems, aims to assist researchers and theorists in comparing various treatment approaches to particular problems. Further, researchers may investigate underlying causal mechanisms and processes of particular diagnoses, which in turn may allow for prevention and improved control over the outcomes of psychiatric disorders (American Psychiatric Association [APA], 2000; Hinkle, 1999; Maniacci, 2002; Mead, Hohenshil, & Singh, 1997). In addition, the DSM provides information about the course, prevalence, cultural, gender, and familial issues related to each diagnosis-information that may be helpful to counselors who are struggling to fully understand their clients' experiences. This understanding, in turn, may enable effective referral and/or planning of counseling, psychotherapy, and other psychiatric treatment strategies (Duffy, Gillig,Tureen, & Ybarra, 2002; Mead et al., 1997; Waldo, Brotherton, & Horswill, 1993). DSM diagnoses may also help mental health counselors to identify those clients whose problems extend beyond the clinician's areas of competence (Eriksen & Kress, 2005).
The DSM may also benefit clients in more personal and direct ways. For example, sometimes clients benefit from an ostensibly concrete explanation of their behavior, and experiences. Labeling clients' behaviors and experiences may offer them freedom from self-blame and the ability to invest their energy more productively in...