Introduction to using and integrating DSM 5 information into ethical and professional treatment planning for masters level counselors.

1. DSM 5 Basic Information and
Introduction to Treatment Planning

2. DO A CLIENT MAP
Diagnosis
Objectives for treatment
Assessment
Clinician Characteristics
Location of Treatment
Interventions
Emphasis of treatment
Numbers
Timing
Medication
Adjunct Services
Prognosis

3. Coding Example
• F34.1 Persistent Depressive Disorder, mild
• severity, with early onset, with pure
• dysthymic syndrome
• Z63.5 Disruption of family by separation
• No longer use 5 axis

4. Code Numbers
 No need to memorize these!
 Your DSM 5 will provide the necessary code
numbers pertinent to certain diagnoses
 Code numbers are listed without consideration to
the five axis system used in previous versions of the
DSM.
 Last, another change is not capitalizing diagnoses
when listing code numbers.
 Z codes are now used in place of V codes that were
used in the previous version of the DSM. Z codes
are better confined to psychosocial and
environmental problems relevant for treatment. For
example, a divorce among parents, loss of child
custody, unemployed, etc.)

5. Functionality
• DSM IV-TR previously required clinicians to use
the GAF scale to provide information about a
client on Axis V.
• The GAF has been abolished in favor of the
WHODAS 2.0 due to the GAF being considered
as a measurement tool that had considerable
psychometric problems with reliability.
• The WHODAS 2.0 has also been considered a
problematic measure due to the have emphasis
on disability and that the scores may not provide
information on mental health symptoms

6. Severity Specifiers
• The severity of symptoms is nothing new, as the
DSM IV-TR used severity specifiers, but is still
different than DSM 5.
• For instance, DSM IV-TR diagnosis of Bipolar I
Disorder with psychotic features
• DSM 5 uses a Likert rating scale for some
diagnoses in order to quantify severity. For
example, consider psychoses in which the
specifier involves clinicians rating symptoms on
a 5-point scale.
• The problem with this approach is that the
scoring system does not provide information
about total functionality.

7. Treatment Planning
 Needs to be client-centered and follow specific
objectives to help someone meet their goal.
 Treatment planning is done in the beginning along
with appropriate diagnosis, but may change as a
function of time. For example, a client may begin to
see you to work on objectives related to depression
and may need to develop a new treatment plan due
to a recent experience with trauma.
 In sum, the treatment plan is a document that can
be used to help clinicians make effective therapeutic
decisions and to document the presence or absence
of progress across time. This plan entails clinician
and client accountability for the outcomes generated
from therapy or rehab services

8. Treatment Planning
• Effective treatment planning is not always
following a rigid structure or set of
procedures.
• Rather, it depends upon effective use of
interventions, the match between client and
clinician characteristics, and the therapeutic
alliance.

9. Objectives
• Collaboration between client and clinician
• Client readiness to participate in therapy
• - expectations
• - motivation
• - severity of disorder
• - perceptions of therapy process

10. Assessment
• Basic background information to paint a
picture or context of client’s life
• These area consist of factors commonly
found in an intake interview:
• - Demographics
• - Cultural Background
• - Physical Characteristics
• - Behaviors
• - Family Background
• - Social Support

11. Assessment
• Assessment may also need to include
psychological testing for diagnostic
clarification or treatment planning.
• For instance, inventories for personality,
mood, or anxiety symptoms.
• Some testing inventories come with computer
software that will provide a diagnosis to you
based upon client responses. Some
examples include MMPI-A and the Jesness
Inventory-Revised

12. Location
• Appropriate referral based upon client needs
• Matching client needs with specific treatments.
For instance, outpatient therapy for an eating
disorder versus inpatient therapy for an eating
disorder
• Finding a treatment based upon the least
restrictive setting and a setting which will provide
cost-effective treatment
• Examples of settings also include day treatment,
sober living facility, PACT services, or possibly
treatment tracks (agency-specific criteria)

13. Interventions
• Theoretical orientation!
• Your use of theory is dictated by insurance,
your views of human nature, and the facility
with which you practice.
• Recommendation may actually be no
treatment
• How would you justify this position?
• The no-treatment recommendation is rarely
used by clinicians

14. Numbers
 Modality of intervention
 For example, individual or group therapy; family therapy;
couples therapy; neurocognitive remediation;
neurofeedback; medication management
 Your numbers recommendation needs to be considered in
light of best practices. For example, person-centered
therapy has been found to be contraindicated for youth with
conduct disorder. Instead, parent management training,
aggression replacement training, and functional family
therapy have been deemed as good practice for youth who
present with conduct disorder.
 The numbers section may also mean that you need to stay
up to date with research and base rates for mental health
symptoms. For example, 30% of clients with SPMI drop out
or stop attending therapy services.

15. Timing
• Frequency of sessions
• Length of sessions
• Timing depends upon diagnosis and severity
of presenting problems.
• Dependent upon theoretical orientation
• Dependent upon philosophy of your
agency/facility

16. Medication
• Be very careful with this section
• Too much information given to clients may
constitute medical advice, which may be an area
in which you do not have competence or
privilege to offer the information
• Best recommendation you may be able to give is
for an evaluation for medication management.
You may also have an opportunity to consult
with a prescriber or psychiatrist at your facility,
with appropriate permission and release of
information.

17. Adjunct Services
• Additional source of support for clients and/or
their family
• Examples include referrals to an individual
who specializes in service, such as nutrition,
legal matters, transportation, housing