Reframing DSM‐IV: Positive Strategies From Developmental Counseling and Therapy

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.

The Convergence of Counseling and Psychiatric Genetics: An Essential Role for Counselors

“…Counselors, who as a group have limited academic training in medical science, are among those mental health professionals who generally are not mindful of their own use of genetic knowledge. Priority in counselor education and professional development curricula generally has not included the latest findings in psychiatric genetics, psychopharmacology, and neuroscience but rather has embraced training that underscores a humane, tolerant, and socially just alternative to the medical model (Ivey & Ivey, 1998, 1999Lee & Walz, 1998;Lewis et al, 2002;McWhirter, 1997). Still, certain aspects of medicalized mental health practice, including knowledge in psychiatric genetics, are unknowingly adopted by members of the counseling profession.…”

“…The role of the counselor as systems interventionist (Kiselica & Robinson, 2001;Lee, 1998;McWhirter, 1997) and contextualist (Ivey, D'Andrea, Ivey, & Simek-Morgan, 2002;Ivey & Ivey, 1998, 1999Thomas, 1996) becomes a humane and ethical imperative and a pivotal instrument in the alleviation of human suffering.…”

“…Psychiatric Association [APA], 2000;Douthit, 2001;Ivey & Ivey, 1998, 1999 serve as salient exemplars of the fashionable, but sometimes indiscriminate, application of the biopsychiatric paradigm.…”

“…With their rich tradition of prevention (Myers, Sweeney, & Witmer, 2000), developmentalism (Ivey & Ivey, 1998, 1999, multiculturalism (Lewis & Arnold, 1998;Sue, Arredondo, & McDavis, 1992;Sue & Sue, 2002), contextualism (D'Andrea, 2000;Ivey & Ivey, 1998, 1999McAuliffe & Eriksen, 1999;Thomas, 1996), and social action (Kiselica & Robinson, 2001; Lee & Walz, 1998), professional counselors have largely eschewed more medical approaches to mental health and have generally been critical of this medicalizing trend (Breggin, 1994(Breggin, , 2001Douthit, 2001;Glasser, 2003;Ivey & Ivey, 1998, 1999. The time may be at hand, however, when it will be necessary for counselors to expand their knowledge base, both to defend their time-honored traditions and to establish a basis for deciding when attention to biopsychiatric findings may be warranted.…”

“…It is often difficult to separate the revolution in psychiatric genetics from other medically informed mental health practices that appear to trivialize profound economic, social, cultural, and historical challenges in the lives of clients. Counselors' strong commitment to developmentally and contextually informed prevention/intervention strategies (Ivey & Ivey, 1998, 1999Myers et al, 2000) and their vision of a practice undergirded by social justice, tolerance, and equity (Kiselica & Robinson, 2001;Lee & Walz, 1998;Lewis, Lewis, Daniels, & D'Andrea, 2002) are frustrated by the nearly ubiquitous use of the psychopathology model of the APA's (2000) DSM-IV-TR to define psychological suffering (Douthit, 2001;Ivey & Ivey, 1998, 1999, to legitimate third-party reimbursement, and to shape mental health research agendas (Kutchins & Kirk, 1997). In addition, counselors have linked overzealous use of the DSM-IV-TR disease model to the burgeoning use of psychotropic medications to treat mental disorders in adults (Breggin, 1994) and children (Breggin, 2001;Zito et al, 2000) and managed care's practice of imposing strict limits on the number of allowable counseling sessions (Minkoff & Pollack, 1997).…”