Using The Diagnostic And Statistical Manual (DSM) With Clients


One of the main diagnostic systems currently used in the medical and mental health realm is the ‘Diagnostic and Statistical Manual (DSM) IV’ (4th version), published by the American Psychological Association (APA). This manual provides a common language and standard criteria for the classification of mental disorders.

How might the information within the DSM be used with clients?

In general we might say that clinical psychologists and psychiatrists commonly carry out a diagnostic interview for mental disorders as part of their initial contact with clients. Counsellors and psychotherapist use the manual less frequently in their assessments. Having said that, it provides a framework to understand the different signs and symptoms of psychiatric disorders and allows different practitioner to converse about a client using the same criteria.

What benefits are there in having an assessment such as the DSM suggests?

As mentioned above, it allows different caregivers, practitioner or health practitioner treating a patient to talk about the client’s presenting issues using a common denominator. In addition to this it allows for choosing an appropriate and proven treatment approach based on years of research.

What are the negative of having such an assessment?

This method basically boxes people into disorders based on criteria, without looking deeper into the underlying reasons for their behavior. In addition to that it simplifies client’s presenting issues through their symptoms and makes them appear as the same or similar to others with the same disorder, which I personally find too simplistic.

I’ve also noticed that clients can hide themselves behind such labels, once given, and as a result portray even stronger issues.

Under what circumstances would this assessment be useful as part of the initial session?

If the use of the DSM is not the only thing used to assess a client, it can help provide clarity and enable the practitioner to compare their assessment with potential other support people in the client’s live.

When might it be beneficial to have the assessment subsequent to the first session?

Being a counsellor, I don’t use the DSM on a regular basis and almost never in the first session. After working with one teenage client of mine I suggested to the parents to get her assessed by a psychiatrist or psychologist for depression. I had done an initial assessment using a questionnaire. With the additional professional opinion I hoped to get support by having another perspective on the client’s presenting issues. It might also support additional ways to enhance the treatment and help the parents get more clarity.


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