Home | Business News | Browse by Publication | J | Journal of Mental Health Counseling

Developing counseling objectives and empowering clients: a strength-based intervention. (Practice).

Article Excerpt
While it is necessary for most mental health counselors to use the DSM and develop traditional treatment plans, arguments have been waged that the DSM and a medical model are not consistent with a strength-based, developmental counseling philosophy. In this article, a strength-based externalization intervention is described that can be used with clients in establishing counseling objectives and goals. This intervention can be useful in encouraging discrimination between DSM diagnostic labels and the client and his or her strengths, developing strength-based counseling goals, and increasing client empowerment.

**********

The purpose of this article is to describe a postmodern intervention that can be useful with clients in establishing rapport, presenting Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Rev., American Psychiatric Association, 2000) diagnoses in a nonpathologizing way, facilitating the development of strength-based counseling goals, identifying client strengths, and externalizing client problems so that clients see that the problem is the problem, and that they are not the problem (White & Epston, 1990). As will be discussed, this intervention lends itself well to both a professional counseling and postmodern perspective to approaching client problems. While this intervention is couched in narrative theory (White & Epston), counselors practicing from a variety of theoretical orientations can use this intervention.

BACKGROUND

Some writers have expressed concern over the counseling professions use of the DSM-IV-TR (APA, 2000). On the one hand, the DSM-IV-TR provides a system for communicating among professionals and obtaining reimbursements. It also provides a way of organizing client behaviors, determining what services clients need, and facilitating interventions and the counseling process (Hinkle, 1999; Hohenshil, 1993,1996). Almost all counseling settings in which community and mental health counselors work require a DSM-IV-TR diagnosis for reimbursement of services (e.g., hospitals, private practice community mental health, and residential settings). When used flexibly, the DSM-IV-TR can provide clues for the counselor to explore in counseling and developing intervention plans with clients (Hinkle). A DSM-IV-TR multiaxial assessment, especially Axes Four and Five, can also alert the counselor to life contexts related to specific diagnoses (White, 2001). The DSM-IV-TR is useful and is certainly a necessity for professional practice. Indeed, the DSM-IV-TR is "here to stay" (Hinkle, p. 45; Hohenshil, 1993).

On the other hand, the word diagnosis is part of the medical illness-cure tradition: Clients are diagnosed with a mental disorder and subsequently obtain treatment to cure their illness; the mental disorder is the person. Thus, a problem-saturated identity is developed or further solidified and reinforced. It can become difficult to escape the labeling, as it is difficult for clients to escape from themselves (Tomm, 1989). A reliance on diagnosing pathology and disorders separate from social context is not consistent with the traditional counseling emphasis on developmental models, multicultural concerns and strength-based approaches (Hershenson, Power, & Waldo, 1996; Ivey & Ivey, 1998; Rigazio-DiGilio, Ivey, & Locke, 1997).

Similarly, the postmodern movement has challenged traditional ways of knowing and standard ways of thinking about assessment and counseling. Counselors have been encouraged to proceed cautiously in ascribing diagnostic labels (Gergen, 1985; Parker, Georgaca, Harper, McLaughlin, & Stowell-Smith, 1995; Segal, 1986). Postmodern thinkers state that we cannot escape the fact that diagnoses and abnormal behaviors are often historically contingent and socially constructed (Maracek, 1993). Thus, definitions of abnormal behavior are not absolute reality--they are derived from cultural and societal definitions of normal. One proposed resolution to the discrepancy between a postmodern perspective and the realities of clinical survival is for counselors to find a balance between traditional clinical diagnosis and a postmodern skepticism...