The Pros and Cons of Viewing Formal Diagnosis From a Social Constructionist Perspective

Over the last few years, counselor training has focused more on formal diagnosis, but this increased focus has been questioned. In the end, the question seems less about whether formal diagnosis will be taught and more about how it will be taught. The author argues that diagnosis should be taught from a social constructionist rather than an objectivist perspective because of the former perspective's humanistic focus. ********** There has been more focus put on formal diagnosis as contained in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000) in counselor training than in the past (Council for Accreditation of Counseling and Related Educational Programs, 2001; Hansen, 2003). With more focus, however, has come more dispute about how diagnosis based on the DSM framework should be taught, with some saying that it should be taught traditionally, some arguing that it should be taught developmentally, some arguing that it should be taught administratively, and some arguing that it should be taught minireally, if at all (Hansen, 2003; Hershenson, 1992; Hohenshil, 1993, 1996; Ivey & Ivey, 1998). Hansen (2003) added fuel to this dispute by arguing that the "essential assumptions" (p. 98) of diagnosis based on the DSM framework do not fit well with counseling's humanistic accent on the individual, holism, and purpose, a humanistic accent that Kirschenbaum (2004) and others have linked to how Carl Rogers's work "continues to serve as a foundation for the counseling profession" (p. 123). Hansen (2003) went so far as to assert that putting more focus on diagnosis based on the DSM framework in counseling might even impede the unfolding of counselor identity. He also realized, however, the critical role diagnostic skill plays in today's clinical practice; thus, he advised that it be included in counselor training, but with a twist: teach it as a "survival skill" (p. 101) rather than as a clinical skill. By doing so, Hansen (2003) aimed to give students diagnostic skill while helping them hold on to their "fundamentally humanistic professional identity" (p. 102). Maybe more important, Hansen's ideas pushed along the trend toward adopting a both / and (de Shazer, 1991, p. 60) over an either / or way of dealing with the issue of diagnosis in counselor training (Ivey & Ivey, 1998). In other words, the issue is not if formal diagnosis will be included in counselor training but rather how it will be included so as to fit in with counseling's humanism (Hansen, 2003; Ivey & Ivey, 1998). I opine that a second "both/and" way of giving students diagnostic skill while holding on to counseling's humanism is to teach diagnosis from a social constructionist perspective. Central to the social constructionist perspective is the belief that reality is created relationally; thus, it might be argued that it fits better with counseling's humanism than does "objectivism" (Lakoff, 1987, p. 158), which says reality is outside and free of human observers (Gergen, 1994; Hansen, 2004). Because most diagnostic training is from an objectivist stance, such training may create a bind for counselors because of conflicting theories (Hansen, 2003; Morrison, 1995; Rentoul, 1995). Does social constructionism offer another stance that fits more with cotmseling's humanistic focus? To look into this prospect, this article is made up of three parts. First, the pros and cons of an objectivist concept of formal diagnosis are reviewed; second, the pros and cons of a social constructionist concept of formal diagnosis are examined; and third, the gist of tutoring counselors in formal diagnosis from a social constructionist point of view is discussed. THE PROS AND CONS OF AN OBJECTIVIST APPROACH TO PSYCHIATRIC DIAGNOSIS An objectivist view that says formal diagnoses depict objective facts with inner, exact origins has been the main view for a long time (Rentoul, 1995). …