By: SOPHIA F. DZIEGIELEWSKI
The DSM-5 states clearly that it was
designed to be used in a wide variety of
settings, including inpatient and outpatient settings and consultation and
liaison work. Furthermore, the DSM-5
was designed
for use by professionals, not as a
self-help book for the
lay public. The DSM is
very complex and could
overwhelm a client unfamiliar with the technical jargon. Therefore,
use by the lay public is
discouraged. Historically, the role of the professional is to interpret the
diagnostic criteria,
inform the client, and work with the client on what the best course of action
would be.
The DSM-IV-TR and DSM-5 both clearly state this philosophy, although Paris (2013) questions
it. He believes that clients have a right to know their own diagnoses and
that the more they
know, the more they are empowered to participate in self-help strategies. Also, with the
Internet and other forms
of information so readily accessible, clients often actively gather information
related to their own mental health. This supports the notion that clients should not be
kept unaware of their
diagnoses and the contributing criteria. To do this creates a disservice that
forces them to be
passive consumers of their own health and mental health care. Most practitioners
would agree
wholeheartedly that client participation in their own health care is essential,
so why not
their own mental health care? Arguments that the DSM is very complex and could overwhelm a client unfamiliar with the technical
jargon have been
questioned, and active client participation has become expected (Paris, 2013).
This active
involvement is confirmed
by the use of technology. Many
clients are savvy in using the Internet to
look up information, and it makes sense that they would not hesitate to look
up information related
to their own health and mental health needs, as well as those of family
members. Unfortunately,
this opens up the client to information that may or may not be accurate,
adequate, or entirely
relevant to his or her situation. Or clients may be in a compromised
cognitive position that
does not allow them to fully integrate this information.
To further
complicate this picture, the Internet is such an open venue that the information gained may not be
reputable and may be misleading
or confusing to the
client or his or her family. Although DSM information is designed for
the professional, when questioned about a
diagnostic assessment and information is shared with the client,
professional awareness and support are essential for the best treatment outcomes.
In certain types
of therapy, it is not
uncommon to share
diagnostic information with the client. For example, in some cognitive
behavioral approaches, a
client may be presented with a list of criteria reflecting the symptoms of a diagnosis and asked which ones he or she has.
Once self-identified, how to behaviorally
address the symptoms may be the next
step. From this, a treatment plan with a clear practice strategy
related to how to either
control the symptoms or avoid them may be implemented. Therefore,
regardless of whether
the DSM
is
designed for professionals,
client-initiated interactions related to this information may occur. Knowing how to
best handle this
situation for the client and his or her family members is an important part of the
therapeutic process.
This book is
designed for professional practitioners who use the DSM-5, including psychiatrists and
other physicians, psychologists, social workers,
occupational and rehabilitation therapists, and other health and mental health
professionals. Although they may all have different training and expertise, they
still are expected to use this categorical and dimensional approach by
applying clinical skill
and judgment to achieve similar determinations. These professionals need
to be trained in how to
use this categorical and dimensional approach and
be aware of its potential for misuse before putting it into practice.
Special care and
consideration are necessary to protect the rights of clients while identifying
issues to be addressed to ensure client benefit and progress.
issues to be addressed to ensure client benefit and progress.
References
SOPHIA F.
DZIEGIELEWSK, 2015, DSM-5TM
in Action, by John Wiley & Sons, Inc.
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