DSM‐5 and Evidence‐Based Family Therapy?

Abstract

The publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) extends a profession and practice-defining direction for family therapy. Warranting and expediting this medicalised direction has been a scientific and administrative coupling of diagnosed symptomatic conditions with evidence-based treatments for addressing those conditions. For systemically or poststructurally oriented family therapists tensions can follow from this direction which we elaborate upon in this article. Specifically, we examine the premises behind this medicalised direction for family therapy, juxtaposing these premises with systemic and post-structural premises of practice. We relate these juxtapositions to tensions family therapists may need to reconcile in their work with families. We close with an overview of this special issue's contributions that pertain to the DSM-5 and family therapy.1 The continuing symptomological and individualistic focus of DSM-5 creates tensions for family therapists who practice from systemic and post-structuralist orientations. 2 A discursive approach enables us to understand how DSM-5 discourse both enables and constrains our understanding of human concerns. 3 DSM-5 does not address relational aspects of practice and creates "linguistic poverty" in limiting understandings of family concerns. 4 Evidence-based practice tied to a medicalised diagnostic classification framework is a seductively algorithmic practice, which reproduces normative, standardised conversations in mapping client concerns to DSM-5based diagnoses. 5 DSM-5-based algorithms of evidence-based practice ignore the importance of context and the ever-changing conversations of human concerns and multiple practices are required to reflect, articulate and work with family concerns effectively.So what is it about the biopolitics of life itself…that provides the spaces within which bioethical authority seems to be required and simultaneously circumscribes the issues to which such ethical concerns appear relevant? (Rose, 2007, p. 31) Welcomed or not, the American Psychiatric Association's (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) will influence the conversations therapists have with families. In writing about diagnostic language as it relates to relationships, Tom Andersen (1996) long ago wrote that "language is not innocent". The diagnoses of DSM-5 cannot be regarded as neutral scientific discoveries, nor can the expected diagnostic practices accompanying the DSM-5's use be

Diagnoses, Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy

“…As a discourse of symptoms alone, the DSM‐5 offers convenient shorthand to classify concerns in ways understandable to other health care professionals. When evidence‐based therapy interventions can then be shown to address such diagnosed symptoms, reassuring and standardizing algorithms of practice seem possible (Sharfstein, ; Steiner, ; Strong & Busch, ). Such an algorithm is then available to administer and standardize how therapy for any diagnosed condition is practiced.…”

Thematic review of family therapy journals in 2013

“…There were two editorials in the Journal of Marital and Family Therapy on DSM‐5 (Lebow, ; Wamboldt, ). There was also a special issue of the Australian and New Zealand Journal of Family Therapy on DSM‐5 (volume 34 issue 2) with articles on DSM‐5 and evidence‐based family therapy (Strong and Busch, ), medical family therapy (Nobbs, ), narrative informed practice (Simblett, ), emotional processes (Chambers et al . ), first order change (Denton and Bell, ) and self and society (Epstein et al .…”

“…There were two editorials in the Journal of Marital and Family Therapy on DSM-5 (Lebow, 2013a;Wamboldt, 2013). There was also a special issue of the Australian and New Zealand Journal of Family Therapy on DSM-5 (volume 34 issue 2) with articles on DSM-5 and evidence-based family therapy (Strong and Busch, 2013), medical family therapy (Nobbs, 2013), narrative informed practice (Simblett, 2013), emotional processes (Chambers et al 2013), first order change (Denton and Bell, 2013) and self and society (Epstein et al 2013). Two emerging themes from these articles were an acknowledgement of the centrality of the DSM to discourse in the international mental health field, and a continuing dissatisfaction among systemic therapists with the DSM classification system, which conceptualizes problems within an individual framework rather than a systemic one.…”

Ethical Family Therapy: Speaking the Language of the Other

“…Their widespread mandated use in public and private mental health practice today poses an ethical practice dilemma for many systemic, narrative, and dialogical family therapists, namely, how to apply them without imposing a colonising and non‐relational way of speaking on others (Rober, )? In this regard, the recent ANZJFT issue on DSM‐5 and family therapy edited by Strong and Busch () provides excellent guidelines for relational and family therapists practicing in an evidence‐based, medicalised context.…”

“…the recent ANZJFT issue on DSM-5 and family therapy edited by Strong and Busch (2013) provides excellent guidelines for relational and family therapists practicing in an evidence-based, medicalised context.…”