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Counseling and the DSM-5 The Professional Counselor from the National Board for Certified Counselors, Inc. and Affiliates Volume 4, Issue 3 Special Issue: Counseling and the DSM-5 The refereed, online, open-source journal promoting scholarship and academic inquiry within the profession of counseling THE PROFESSIONAL COUNSELOR Volume 4, Issue 3 Special Issue: Counseling and the DSM-5 Dr. Matthew R. Buckley, Guest Editor THE PROFESSIONAL COUNSELOR The journal promoting scholarship and academic inquiry within the profession of counseling Visit our Web site Manuscript Submission Forms Book and Video Reviews Digests Editorial Board 2014 Editorial Staff Susan A. Adams Michael Alan Keim Thomas W. Clawson, Publisher Walter P. Anderson, Jr. Budd L. Kendrick J. Scott Hinkle, Editor Janine M. Bernard Joel Lane Michelle Gross, Associate Editor Loretta J. Bradley Jeffrey S. Lawley Traci P. Collins, Managing Editor Kathleen Brown-Rice Sonya Lorelle Verl T. Pope, Associate Editor Matthew R. Buckley Raul Machuca Jay Ostrowski, Technical Editor Rebekah Byrd Amie A. Manis Allison Jones, Editorial Assistant Keith A. Cates Mary-Catherine McClain Carie McElveen, Editorial Assistant Rebecca G. Cowan See (Susie) Ching Mey Stephanie Crockett Matthew J. Mims Joel F. Diambra Keith Morgen Peggy A. Dupey Kirsten W. Murray Judith C. Durham Jason K. Neill Mark Eades Adele Logan O’Keefe Bradley T. Erford Jay Ostrowski Edwin R. Gerler, Jr. Fidan Korkut Owen Gary G. Gintner Richard L. Percy Samuel T. Gladding J. Dwaine Phifer Barry Glick Patricia J. Polanski Yuh-Jen Martin Guo Verl T. Pope W. Bryce Hagedorn Theodore P. Remley, Jr. Lynn K. Hall James P. Sampson, Jr. George E. Harrington Syntia Santos Stephen Hebard Stephen R. Sharp Tanya Johnson Antonio Tena Suck Laura K. Jones Ann K. Thomas Joseph P. Jordan Jeffrey M. Warren About The Professional Counselor The Professional Counselor (TPC) is the official, open-source, electronic journal of the National Board for Certified Counselors and Affiliates, Inc. (NBCC), dedicated to research and commentary on empirical, theoretical, and innovative topics in the field of professional counseling and related areas. TPC publishes original, peer-reviewed manuscripts relating to the following: mental and behavioral health counseling; school counseling; career counseling; couples, marriage, and family counseling; counseling supervision; theory development; professional counseling issues; international counseling issues; program applications; and integrative reviews of counseling and related fields. The intended audiences forTPC include National Certified Counselors, counselor educators, mental health practitioners, graduate students, researchers, supervisors, and the general public. The Professional Counselor © 2014 NBCC, Inc. and Affiliates National Board for Certified Counselors 3 Terrace Way Greensboro, NC 27403-3660 Volume 4, Issue 3 Table of Contents 159 Back to Basics: Using the DSM-5 to Benefit Clients Matthew R. Buckley, Guest Editor 166 Historical Underpinnings, Structural Alterations and Philosophical Changes: Counseling Practice Implications of the DSM-5 Stephanie F. Dailey, Carman S. Gill, Shannon L. Karl, Casey A. Barrio Minton 179 DSM-5 Conceptual Changes: Innovations, Limitations and Clinical Implications Gary G. Gintner 191 The Removal of the Multiaxial System in the DSM-5: Implications and Practice Suggestions for Counselors Victoria E. Kress, Casey A. Barrio Minton, Nicole A. Adamson, Matthew J. Paylo, Verl Pope 202 Clinical Application of the DSM-5 in Private Counseling Practice Jason H. King 216 Evaluating Emerging Measures in the DSM-5 for Counseling Practice Erika L. Schmit, Richard S. Balkin 232 Revising Diagnoses for Clients with Chronic Mental Health Issues: Implications of the DSM-5 Laura E. Welfare, Ryan M. Cook 246 The Expansion and Clarification of Feeding and Eating Disorders in the DSM-5 Maureen C. Kenny, Mérode Ward-Lichterman, Mona H. Abdelmonem 257 Trauma Redefined in the DSM-5: Rationale and Implications for Counseling Practice Laura K. Jones, Jenny L. Cureton 272 DSM-5: A Commentary on Integrating Multicultural and Strength-Based Considerations into Counseling Training and Practice Saundra M. Tomlinson-Clarke, Colleen M. Georges 282 DSM, Psychotherapy, Counseling and the Medicalization of Mental Illness: A Commentary from Allen Frances Allen Frances, MD viii Back to Basics: Using the DSM-5 to Benefit Clients The Professional Counselor Volume 4, Issue 3, Pages 159–165 http://tpcjournal.nbcc.org © 2014 NBCC, Inc. and Affiliates Matthew R. Buckley doi:10.15241/mrb.4.3.159 It is a pleasure to introduce this special DSM-5 edition of The Professional Counselor, which provides a solid primer regarding changes in the DSM-5 diagnosis process and how these changes will likely impact mental health professionals. Changes within the DSM-5 have prompted counselors to revisit the basics of diagnosis and consider the cessation of certain conventions (e.g., the multiaxial system) and what these changes mean to counselors as they perform their vital work for the benefit of clients. The unprecedented inclusion of various mental health professionals in the development of the DSM-5 is an inherent recognition of how this tool is being used across a wide range of professional disciplines that focus on psychopathology. I hope these articles not only inform, but encourage further research into the practical use of the DSM-5, “stimulate new clinical perspectives” in mental illness (American Psychiatric Association [APA], 2013, p. 10), and inspire continued professional dialogue around DSM nosology and the diagnostic processes. Keywords: DSM-5, diagnosis, psychopathology, mental illness, multiaxial system The fifth edition of theDiagnostic and Statistical Manual for Mental Disorders (DSM-5) is an update of a major diagnostic tool (APA, 2013). The manual was originally designed to help mental health professionals within a wide variety of disciplines assess and conceptualize cases in which people were suffering from mental distress. This conceptualization is important in that it facilitates an understanding in a common language toward the development of treatment planning to address complex and entrenched symptomology. The DSM has undergone numerous iterations and represents the current knowledge of mental health professionals about mental illness (APA, 2013). One of the primary aims of the DSM-5 workgroups was to align the manual with the current version of the International Classification of Diseases (ICD-9). In addition, political, social, legal and cultural dynamics influenced the development of theDSM-5 —and not without controversy (Greenberg, 2013; Locke, 2011; Linde, 2010; Pomeroy & Anderson, 2013). As with any tool, concerns have emerged about the potential of misuse. It is the professional responsibility of skilled and ethical mental health counselors and other professionals to prevent misapplication of the manual (American Counseling Association [ACA], 2014, E.1.b, E.5.a–d). Walsh (2007) succinctly noted that “the primary goal of the DSM is to enhance the care of individuals with psychiatric disorders” (p. S3). The introduction of the DSM-IV-TR states that the DSM has been used by numerous mental health practitioners (APA, 2000), with no mention of their investment as legitimate stakeholders in the process of DSM development. Well before the final revision of theDSM-5 , various mental health professionals, organizations and other relevant collaborators helped formulate the manual in unprecedented capacities. In the introduction to the DSM-5 (APA, 2013) the authors intentionally state that numerous stakeholders were involved in DSM- 5 development including counselors and “patients, families, lawyers, consumer organizations, and advocacy groups” (p. 6). Of particular note was the inclusion of national organizations such as the ACA in the form of a Matthew R. Buckley, NCC, is a faculty member in the Mental Health Counseling program at Walden University, Minneapolis, MN. Correspondence can be addressed to Matthew R. Buckley, Walden University, 100 Washington Avenue South, Suite 900, Minneapolis, MN 55401-2511, [email protected]. 159 The Professional Counselor\Volume 4, Issue 3 DSM-5 task force, which submitted position statements and recommendations to the APA. Various mental health professionals participated directly in the formulation of the DSM-5, primarily in field trials which “supplied valuable information about how proposed revisions performed in everyday clinical settings” (p. 8). Much of the data supports the use of more than 60 cross-cutting and severity symptom measures (see http://www.psychiatry. org/practice/dsm/dsm5/online-assessment-measures). Clinical Utility First (2010) reported that utilizing broad and diverse populations of mental health professionals provides rigor for clinical utility. Achieving clinical utility within the DSM diagnostic processes meets the following four objectives: 1. to help clinicians communicate clinical information to other practitioners, to patients and their families, and to health care systems administrators; 2. to help clinicians implement effective interventions in order to improve clinical outcomes; 3. to help clinicians predict the future in terms of clinical management needs and likely outcomes; and 4. to help clinicians differentiate disorder from non-disorder for the purpose of determining who might benefit from disorder-based treatments. (First, 2010, p. 466) Any changes to the DSM were framed within the context of how they might be utilized by all mental health
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