Read Buckley’s 2014 article, “Back to Basics: Using the DSM-5 to Benefit Clients,” from The Professional Counselor, volume 4, issue 3, pages 159–165. This article examines how the DSM-5 can be used to formulate treatment decisions that result in the best outcomes for clients.
After reading the required articles for this unit, give consideration to your own views on diagnosis. Based on your past experiences, what is the best approach to use when working with the clients at your site to formulate a diagnosis? What factors are important to assess in the diagnostic process? How do these factors drive the treatment planning process and interventions selected?
PART 2 OF THE ASSISGNEMENT
You will write a response to each peer’s posting which is expected to be substantive in nature and to reference the assigned readings, as well as other theoretical, empirical, or professional literature, to support your views and writings. Reference your sources using standard APA guidelines. Support the response with at least two references.
PEER ONE POST
The clients coming into my site are coming specifically for substance abuse. Many already come in with diagnosis, however even if they did not the counselor is not allowed to make the diagnosis; the LMHC makes the diagnosis when clients are referred to her for more mental health focused treatment. They are not required to make a diagnosis because the agency is substance abuse based and the focus is the use, any mental health concerns are handled by an outside agency. From being in the group supervision this learner found out that sometimes with insurance companies it is necessary to make a diagnosis within one or two visits in order for the client to be covered.
Important factors to consider in the diagnostic process are the differential diagnosis. Relational problems are more complex than individual problems; they have been under evaluated and have been failed to be looked at as important to disorders (Beach et al, 2006). Relational problems are considered by the clinician when the individual’s relationships affect the course, prognosis, or treatment of their mental or medical disorder (American Psychiatric Association). Relationships have been shown to have an impact on mental and medical health. The DSM-5 contains V and Z codes that are aimed at relational problems which include (1) problems related to family upbringing: parent-child relational problem, sibling relational problem, upbringing away from parents, child affected by parental relationship distress, (2) other problems related to primary support group; relationship distress with spouse or intimate partner, disruption of family by separation or divorce, high expressed emotional level within family, and uncomplicated bereavement (American Psychiatric Association). It is also important to consider, Education/Work; ex. 1. Code V62.3 (Z55.9) academic or educational problem, 2. Code 62.29 (Z56.9) other problem related to employment; Housing/Economic Problems: ex. 1. Code V60.89 (Z59.2) discord with neighbor, lodger, or landlord, 2. Code V60.6 (Z59.3) problem related to living in a residential institution; and possible medical conditions. The counselor would also need to take into consideration the clients cultural background into consideration; what might be odd from your own culture can be normal for their culture.
This learner feels that the counselor must be careful in the diagnosis because the diagnosis will shape the treatment planning process. This is why it is important to consider the factors when making a diagnosis.
During the group supervision, this week the group did regular check ins in which we all discussed intakes we had last week or on Monday. An important topic that we discussed was what happens at each member’s site when you encounter a suicide patient such as what the procedure is, protocol, and follow up process. Every group member also explained the process of note and how documentation is handled. For example, one student did all paper notes, while other scanned in a computer paper notes, and others just did everything right into the computer with the use of no paper. The group also discussed SLAP which stands for Specific, Lethal, Available, and Proximity which is a quick suicide assessment that can be used in the counseling setting. Lastly, we talked about not being afraid to bring up the topic of suicide and ask questions because you will not implant the idea in the client.
DSM Library. (n.d) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association. Retrieved from: http://dsm.psychiatryonline.org.library.capella.edu/doi/full/10.1176/appi.books.9780890425596.AssessmentMeasures.
Beach, S.R.H., Wamboldt, M.Z., Kaslow, N.J., Heyman, R.E., & Reiss, D. (2006). Describing relationship problems in DSM-V: Toward better guidance for research and clinical practice. Journal of Family Psychology. 20(3), 359-368.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2014). Clinical Interviewing (5th e.d). Hoboken, NJ: John Wiley & Sons Inc.
PEER TWO POST
This author has not gotten to a point of diagnosing a client at her site as of yet. From what I can tell, the therapists utilize the DSM-V. Remember back from a recent class I took, I recall taking into consideration all of the provided medical information of the client, (incl. past hx); and in this particular class we used a chart. It was like a tree chart with symptoms and you follow the tree based on the symptoms, but you also have to utilize the DSM-V because it will be very specific of about timeframes, or how often someone would have had to have a particular set of symptoms to be diagnosed.
In my office, they utilize the DSM-V, but they code diagnosis in their system using the ICD-10.
It is this author’s belief that there are clients who want a diagnosis, because it puts a name to what they’re feeling, but there are those who do not want the stigma of being diagnosed with anything. Diagnosing gives the clinician an idea of what he/she is treating, and what the typical protocol may possibly be for that diagnosis. As Sommers and Flanagan puts it, “treatment can be developed for a specific diagnoses.” (p. 399)
The Buckley (2014) in the article, Back to Basics: Using the DSM-5 to Benefit Clients, six ideas to consider when diagnosing. Those are:
“to what extent signs and symptoms may be intentionally produced;
“to what extent signs and symptoms are related to substances;
to what extent signs and symptoms are related to another medical condition;
to what extent signs and symptoms are related to a developmental conflict or stage;
to what extent signs and symptoms are related to a mental disorder; and
whether no mental disorder is present.”
These ideas to consider will help to rule out other issues that may be influencing a diagnosis.
This week was a very difficult week for me. We had two faculty supervisions. It was tough to maneuver because my time is very limited now. On top of that this week’s faculty supervision was difficult. We briefly discussed Suicide. I am personally going thru some things with my son and it is taking every bit of me to hold things together. With all of the education and training we receive, when you are personally connected to someone who is dealing with some MH issues, specifically depression and anxiety, you often second guess yourself and wonder what you should do and when. It’s very difficult.
On another note, at the make-up faculty supervision it was good to hear Dr. Warran tell us that our focus should truly be on foundational skills and not a specialized approach.
The second supervision this week was helpful as well. I like when Dr. Warren does a structured interactive lecture-type supervision and then move into discussing the things we’re dealing with at our site.
Buckley, Matthew R. (2014) Back to Basics: Using DSM-5 to Benefit Clients, The Professional Counselor, 4(3), pp. 159-165.
Sommers-Flanagan, John, and Sommers-Flanagan, Rita. (2017). Clinical Interviewing, 6th Ed., WILEY AND SONS, INC.