DIAGNOSING
TO DIAGNOSE OR TO NOT DIAGNOSE?
The DSM-V oversimplifies human behavior because all someone must do to be diagnosed with a mental illness is check a few boxes that apply to them (Fritscher, 2020). Then, based on the diagnosis, there is a prescribed treatment plan. Whereas a marriage and family therapist not using the DSM-V will have several different treatment approaches to choose from that they feel fits the situation best. Nevertheless, while it is essential to be aware of the systemic factors surrounding an individual, there is value to the classifications found within the DSM because they provide us with a guidepost in deciding treatment (Lebow, 2013).
An argument against diagnosing is the ethical dilemma for family therapists using the DSM-V to misfit diagnoses for insurance purposes (Strong & Busch, 2013). Family therapists must balance using two different lenses when incorporating the DSM-V. One lens is the systemic view and is used for treatment while another lens uses the DSM-V for diagnosis (Denton & Bell, 2013). Unfortunately, this can lead to an increased risk of misdiagnosis and/or over diagnosis. Assigning a DSM-V diagnosis can be argued that the diagnosis is a description of the patient’s self-reported problem and doesn’t account for the possible causes of the problem (Denton & Bell, 2013). People can easily be labeled as having a mental disorder because their behavior may not be seen as the typical normal and their behavior checks some boxes on the DSM-V (Fritscher, 2020). However, if the context and the environment was looked at, then maybe they wouldn’t be labeled with a diagnosis. A common example of this was when a language shift occurred from the DSM-IV to the DSM-V and more children became diagnosed with ADHD and an increase of Ritalin was prescribed (Fritscher, 2020). There is a unique human element that encompasses a systemic approach and there is a worry that if complex problems become reduced to labeled boxes, then the scientific community risks losing track of that unique human element (Fritscher, 2020). There is also a concern for treatment fidelity because as a family therapist, the therapist wants to choose the best possible outcome for their patient and the DSM-V could potentially cloud judgment and cause treatment infidelity towards their patient (Strong & Busch, 2013).
Even so, our healthcare system currently operates under the disease model, and in many cases, a therapist needs to provide an individual diagnosis to receive reimbursement (Lebow, 2013). As MFTs, it can be disheartening to have to think of an identified patient because we are systemic view thinkers. However, diagnosing a client does not have to change the way that we view our work. Considering the way healthcare currently runs, diagnosing a person in the room displaying enough symptoms to fit a DSM diagnosis may be necessary if we work with insurance (Billing for Couples and Family Therapy, 2020).
What are your thoughts?
Written by: Crystin Nichols, MFTI
Billing for Couples and Family Therapy. (2020, September 8). Navigating the Insurance Maze.
Denton, W. H., & Bell, C. (2013). DSM-5 and the Family Therapist: First- order Change in a New Millennium. Australian and New Zealand Journal of Family Therapy, 34(2), 147–155.
Fritscher, L. (2020, June 19). Advantages and Disadvantages of the Diagnostic Statistical Manual. Verywell Mind.
Lebow, J. L. (2013). Editorial: DSM-V and Family Therapy. Family Process, 52(2), 155–160.
Strong, T., & Busch, R. (2013). DSM-5 and evidence-based family therapy? Australian and New Zealand Journal of Family Therapy, 34(2), 90–103.
