In need of a 250 word response/discussion to each of the following forum posts. Agreement/disagreement/and/or continuing the discussion.
Original forum discussion/topic post is as follows:
In your initial post this week, either advocate for the use of clinical diagnoses in mental health practice or for not using them. Be sure to include the ethical issues associated with the position you choose.
In your peer responses, please reflect on how your peer’s choices, examples, etc. are similar or different from your choices.
forum post response #1
this weeks forum asks if we are able to advocate either for the use of clinical diagnosis in mental health practices or for not using them. I cannot help but feel this is a very controversial subject. I also am not sure how exactly how I feel. I am almost on the fence, and hesitant on both parts. I truly feel it depends on the severity of the client’s issues, as well as the rapport I may or may have not built. Ethically, in order to set a diagnosis I feel that the clinician should be fully knowledgeable of the clients case notes (awareness, interventions, goals, etc,). Assessments are taking periodically through each treatment and session, these are also critical to using a diagnosis.
Going with not advocating for clinical diagnosis being used, I do feel that when it comes to “diagnosis” some use this as a stamp to explain why a client acts the way they act. For example, diagnosing a client with Schizophrenia explains why this individual has delusions, hallucinations, lack of motivation, and issue with thinking. But in reality, if there has been no support of this, as a clinician you place a diagnosis to help them “make sense” of their behavior. Another example advocating against using clinical diagnosis is that when it comes to PTSD, not saying that PTSD is not a acute diagnosis. PTSD is a disorder which occurs when an individual has experienced or witnessed a traumatic event (natural disaster, serious accident, terrorist act, war/combat, rape or violent personal assault). With Veterans, most who have been diagnosed with PTSD have been diagnosed due to the war/combat, or terrorist attack aspect, without having prior history of mental health diagnosis, but then it usually is followed up with other diagnosis.
Ethically, the issues that arise with diagnosis can fall under majority of the principles of the APA Ethics code. Following up and supporting advocating not to use diagnosis in mental health, many theorist such as Gestalt value the experience of the client, versus the diagnosis aspect. When looking from a Cognitive-Behavior therapists point of view, they focus on the relationship between the thinking pattern and behavior, with little interest in diagnosis. With psychodiagnosis, therapists utilize the DSM-V as guidelines to diagnosis, yet this just focuses on pathology, without taking into consideration the uniqueness, and like I mentioned prior, the severity of the client’s issues. Simply because each individual client is different. When a diagnosis is formulated, the clinician has to be fully aware and cognitive of all ethical aspects and factors of the individual to include medically and most importantly, culturally.
Forum post response #2
Happy New Year! I hope 2019 will be a good year for all of you. This week we are asked to choose a side of whether or not we advocate for the use of clinical diagnoses in mental health practice. My response is two-fold because clinical diagnosis is based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5). The DSM is a resourceful tool because it is a quick reference guide to understanding the collection of behaviors associated with certain disorders or syndrome. It is the baseline or starting point for a doctor or psychologist. A significant downfall of the DSM is that it is based on the normative view, which is heavily influenced by social norms. At one point, homosexuality was viewed as a disorder. Furthermore, people do not fit nicely into those categories because some behaviors may overlap or not be as prominent. It can be especially confusing when comorbidity occurs among disorders and trying to determine which disorder is the primary cause versus secondary effect. Another aspect to consider is the severity of the disorder. The DSM provides scales, but there is no real objective measure. Through the years the DSM has both reliability and validity issues. In the latest version, the framers attempted to improve the reliability, but it still fell short with making subsets of a disorder more distinguishable. As for validity, some are concerned that the diagnostics were derived from weak research. To reiterate, the DSM is a tool, but should not be the sole method for diagnosing.
Using the clinical diagnosis is basically labeling a person and in some cases that label can be more harmful than helpful. A clinical diagnosis can cause issues in the job setting, societal integration, and self-esteem. Unfortunately, there are some cases when a diagnosis is necessary especially for medical insurance or obtaining school services. As mentioned in Dr. Mason’s lesson, diagnoses are dynamic and can change throughout the therapeutic treatment. Personally, I would document the symptoms and potential causes to tailor treatment, but would not focus on the actual diagnosis. One thing to consider is how homosexuality was viewed as a mental illness a few decades ago and now that it is viewed socially acceptable it is no longer in the DSM. Imagine how the people that were diagnosed at the time feel. Do you believe it cause greater mental anguish?
Forum Post response #3
For this week’s discussion forum, we are required to either advocate for the use of clinical diagnoses in mental health practice or for not using them. I must say, choosing a side has been very challenging. In fact, I can see that this topic is one that has been considered controversial for quite some time. But, outweighing the pros with the cons, the choice that I have made is to advocate for the use of clinical diagnosis in mental health practice.
One of the crucial elements to take into consideration when discussing clinical diagnosis is the treatment process and third-party reimbursement. Many insurance companies require that a diagnosis is made, and progress is being reported in order for the therapist to receive payment. Being able to diagnose a client with a psychological disorder also helps to rule out any underlying medical issues that could be present. Another positive aspect of using clinical diagnosis is establishing a common language amongst the professionals within the field. This is beneficial when it comes the educating others within the study of psychology, as well as understanding the different forms of psychological disorders. Furthermore, pinpointing a diagnosis can be beneficial when working towards positive goals within the therapy sessions. Many different types of therapists including behavior therapists, person-centered therapists, and existential therapists rely on the assessment and diagnostic processes within therapy and believe that it is essential to treatment planning and overall success.
An ethical issue that is associated with the use of clinical diagnoses in mental health practices is over diagnosis, under diagnosis, and misdiagnosis. The argument is that many therapists are not properly trained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) leading to them improperly diagnosing their clients, which is considered unethical and fraudulent. Improperly diagnosing a client can lead to many other issues. For instance, if a client is diagnosed with a disorder in which they do not actually have, they could be placed on medicine that they do not actually need and work within a treatment plan that will not benefit them. Not only would this be unhelpful to the client, it can also be harmful to their health and safety. It is important for therapists who are using clinical diagnoses to be properly trained in the DSM-5 in order to prevent improperly diagnosing clients. Furthermore, therapists need to ensure that they are taking medical background as well as cultural backgrounds into consideration when making a diagnosis.
Overall, the use of clinical diagnoses in mental health is beneficial for the client as well as the therapist. When a diagnosis is made, the therapist can pinpoint the treatment that is most effective for clients with such diagnoses. Therefore, the client is able to effectively work within a treatment plan that will ultimately benefit them.