Clinical psychologists and psychiatrists commonly carry out a diagnostic interview for mental disorders as part of their initial contact with clients. Counsellors and psychotherapist do this less frequently.
Diagnostic tool: DSM IV
One of the main diagnostic systems currently used is the ‘Diagnostic and Statistical Manual (DSM) IV’, published by the American Psychological Association (APA). This manual provides a common language and standard criteria for the classification of mental disorders. Even though the manual, with its diagnostic classifications, is widely used throughout the medical and mental health system in many countries beyond the USA; it has also attracted controversy and criticism.
In its historical development it is interesting to note that it has been revised five times since its first publication in 1952, with the last revision in 1994 plus a ‘text revision’ in 2000. Over the years they gradually included more mental disorders and some have been removed, for example ‘homosexuality’. The fifth edition is in planning and preparation and is due to come out in 2013.
What is it used for and why?
The manual, as mentioned above, is mainly used in the medical world and in the mental health system. Hospital staff, clinic staff and insurance companies use it to communicate about a patient’s diagnosis after they have evaluated them. The DSM has also been used to categorize patients for research purposes.
When used by people without adequate training it can lead to inappropriate application and labeling of people’s behavior, which is part of the criticism.
Models of treatment
The medical and mental health approach to treating clients often shows an emphasis on problems, disorders and distress. The treatment involves medication, behavior modification, cognitive behavior therapy or admission to clinics or treatment centers.
Client focused approaches like psychodynamic therapy or psychoanalytical therapy work with the premise that human beings are all the same, have experienced suffering or catastrophes in their lives and are generally working with client’s historical problems in order to find reasons for their presenting issues. These approaches believe that the client is able to work towards their own well-being in a self-regulating fashion.
It is important in my view to keep your eyes and ears open for what the client is presenting regarding their internal and external world, both in what is happening in present and what has happened in the past, rather than relying solely on a tool such as the DSM IV. I am continuously amazed by my clients when seeing the bigger picture of what they present with and the changes that can occur once past trauma and suffering has been healed.