The DSM-5: A Postmodern Re-Vision for Counseling (Handout)

The DSM-5:
A Postmodern Re-Vision
for Counseling
Education Session
American Counseling Association
Jeffrey T. Guterman, Ph.D.
Clayton V. Martin, M.S.
Sunday, March 15, 2015
8:45 a.m. – 10:15 a.m.
American Counseling Association
2015 Annual Conference
Orlando, Florida
Hyatt Regency, Manatee Spring I & II
Copyright © 2015 by Jeffrey T. Guterman and Clayton V. Martin
The PowerPoint for this Education Session is available at http://JeffreyGuterman.com

The DSM-5: A Postmodern Re-Vision for Counseling 2
Contents
About the Presenters ............................................................................................................... 3
Selected Publications by the Presenters .................................................................................. 4
Education Session Description ............................................................................................... 5
Education Session Description ............................................................................................... 5
ACA’s Code of Ethics and Diagnosis ..................................................................................... 6
S.M.A.R.T. Goals for Overcoming Limitations of Diagnosis ................................................ 7
Identifying Exceptions to Limitations of Diagnosis................................................................ 7
Questions for Amplifying Exceptions to Limitations of Diagnosis ........................................ 7
Outcome Rating Scale (ORS) ................................................................................................. 8
Session Rating Scale (SRS) .................................................................................................... 9
Child Outcome Rating Scale (CORS) ................................................................................... 10
Child Session Rating Scale (CSRS) ...................................................................................... 11
Young Child Outcome Rating Scale (YCORS) .................................................................... 12
Young Child Session Rating Scale (YCSRS) ....................................................................... 13
Suggestions and Considerations for Using Rating Scales and Client Feedback .................. 14
References and Suggested Readings ..................................................................................... 15
Suggested Internet Resources ............................................................................................... 18

About the Presenters
Jeffrey T. Guterman, Ph.D. is a mental health counselor in Fort Lauderdale, Florida. He is
author of over 125 publications. The first edition of his book Mastering the Art of Solution-
Focused Counseling was published by the American Counseling Association (ACA) in 2006,
it was translated in Korean in 2007, and an updated and expanded second edition was
published by ACA in 2013. He has presented numerous workshops on solution-focused
counseling.
Contact Information
Email: jguterman@gmail.com
Phone: 305-725-4583
Web: http://JeffreyGuterman.com
Twitter: http://twitter.com/JeffreyGuterman
Clayton V. Martin, M.S. is a counselor in Atlanta, Georgia. He has presented workshops on
the topics of strength-based approaches to counseling and LGBTQ advocacy issues in
counseling. He has written articles for counseling journals on solution-focused approaches to
counseling and philosophical issues in counseling. He has extensive clinical experience in
solution-focused counseling with children, adolescents, and young adults in various clinical
settings.
Contact Information
Email: cmartin51277@gmail.com
Phone: 404-449-3028
–
Jeffrey T. Guterman, Ph.D. and Clayton V. Martin, M.S. are available to provide training and
workshops for your organization on various topics. Program topics and formats will be
tailored to meet the needs of your organization.

Selected Publications by the Presenters
de Castro, S., & Guterman, J.T. (2008). Solution-focused therapy for families coping with
suicide. Journal of Marital and Family Therapy, 34, 93-106.
Guterman, J. T. (1994). A social constructionist position for mental health counseling.
Journal of Mental Health Counseling, 16, 226-244.
Guterman, J.T. (1996a). Doing mental health counseling: A social constructionist re-vision.
Guterman, J.T. (1996b). Farewell to families: Language systems in the postmodern era. The
Family Journal: Counseling and Therapy for Couples and Families, 4, 139-142.
Guterman, J.T. (1996c). Reconstructing social constructionism: A reply to Albert Ellis.
Guterman, J.T. (1996d). Tales of mental health counseling. Journal of Mental Health
Counseling, 18, 300-306.
Guterman, J.T. (1998). Identifying pretreatment change before the first session. Journal of
Mental Health Counseling, 20, 370-374.
Guterman, J.T. (2013). Mastering the art of solution-focused counseling (2nd
ed.).
Alexandria, VA: American Counseling Association.
Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious
and spiritual concerns. Counseling and Values, 51, 39-52.
Guterman, J. T., Martin, C.V., & Kopp, D.M. (2012). Science and humanities: A necessary
unity for the counseling profession. Journal of Humanistic Counseling, 51, 145-154.
Guterman, J.T., & Martin, C.V. (in press). Using puppets with aggressive children to
externalize the problem in narrative therapy. In (A.A. Drewes & C. Schaefer, Eds.),
School age play therapy. Washington, DC: American Psychological Association.
Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine
headache. The Family Journal: Counseling and Therapy for Couples and Families,
13, 195-198.
Guterman, J.T., & Schildbach, J. (2014, June). The stigma of mental illness and the noble
savage. Counseling Today, pp. 60-63.
Martin, C.V., Guterman, J.T., & Kopp, D.M. (2012). Extending the dialogue about science
and humanities: A reply to Hansen. Journal of Humanistic Counseling, 51, 161-163.
Martin, C.V., Guterman, J. T., & & Shatz, K. (2012). Solution-focused counseling for eating
disorders. VISTAS, 1-11.

Education Session Description
The DSM-5 is a limiting and stigmatizing diagnostic nosology that offers little to inform
treatment for the complex and unique issues that clients present to counseling. If counselors
intend to function effectively in mental health systems, it is necessary to address the
shortcomings of the DSM-5. In this session, postmodernism is presented as an alternative
framework for counselors to use the DSM-5 in keeping with both their personal values and
defining features of the counseling profession. Postmodernism corresponds to a reaction
against modernist conceptions of certainty, objectivity, and truth. Postmodern conceptual
frameworks are presented for the DSM-5. Various postmodern counseling techniques are
presented to assist clients in overcoming limiting and stigmatizing effects of diagnosis.
Education Session Objectives
1. Identify and review historical developments of mental illness and the DSM-5.
2. Identify and review clinical implications of the DSM-5 from a modernist epistemological
framework.
3. Identify and review postmodern conceptual frameworks as a basis to resolve conflicts
between the DSM-5, and both the personal values of counselors and defining features of the
counseling profession.
4. Identify and review postmodern counseling techniques to assist clients in overcoming
limiting and stigmatizing effects of the DSM-5.

ACA’s Code of Ethics and Diagnosis
Following is the Introduction and a selection of standards from section E of the ACA’s 2014
Code of Ethics.
 Introduction (Section E)
Counselors use assessment as one component of the counseling process, taking into account
the clients’ personal and cultural context. Counselors promote the well-being of individual
clients or groups of clients by developing and using appropriate educational, mental health,
psychological, and career assessments.
 E.5.a. Proper Diagnosis
Counselors take special care to provide proper diagnosis of mental disorders. Assessment
techniques (including personal interviews) used to determine client care (e.g., locus of
treatment, type of treatment, recommended follow-up) are carefully selected and
appropriately used.
 E.5.b. Cultural Sensitivity
Counselors recognize that culture affects the manner in which clients’ problems are defined
and experienced. Clients’ socioeconomic and cultural experiences are considered when
diagnosing mental disorders.
 E.5.c. Historical and Social Prejudices in the Diagnosis of Pathology
Counselors recognize historical and social prejudices in the misdiagnosis and pathologizing
of certain individuals and groups and strive to become aware of and address such biases in
themselves or others.
 E.5.d. Refraining from Diagnosis
Counselors may refrain from making and/or reporting a diagnosis if they believe that it
would cause harm to the client or others. Counselors carefully consider both the positive and
negative implications of a diagnosis.

S.M.A.R.T. Goals for
Overcoming Limitations of Diagnosis
 Specific Goals
 Measurable Goals
 Achievable Goals
 Relevant Goals
 Time-based Goals
Identifying Exceptions for
Overcoming Limitations of Diagnosis
 Presuppositional questions: Ask, “When has there been a time when _____ (the
problem) has not happened?” or “When has _____ (the goal) happened?” rather than,
“Has there been a time?
 Identifying small exceptions
 Identifying potential exceptions
o The miracle question:
Suppose that one night there is a miracle and while you are sleeping the
problem . . . is solved: How would you know? What would be different?
(de Shazer, 1988, p. 5)
Questions for Amplifying Exceptions to
Limitations of Diagnosis
 How did you make it happen?
 How is that different from how you have dealt with the problem in the past?
 How did it make your day go differently?
 Who else noticed?
 What did you tell yourself to make it happen?
 What does this say about you and your ability to deal with the depression?
 What are the possibilities?

Outcome Rating Scale (ORS)
This scale is for illustration purposes only. The actual scale, which includes 10-centimeter
lines for each item, may be downloaded from http://www.scottdmiller.com. Adapted from
Guterman (2013) and used with permission of Scott D. Miller (http://www.scottdmiller.com).
Name ________________________Age (Years):____ Sex: M / F
Session # ____ Date: ________________________
Who is filling out this form? Please check one: Self_______ Other_______
If other, what is your relationship to this person? ____________________________
Looking back over the last week, including today, help us understand how you have been
feeling by rating how well you have been doing in the following areas of your life, where
marks to the left represent low levels and marks to the right indicate high levels. If you are
filling out this form for another person, please fill out according to how you think he or she
is doing.
ATTENTION CLINICIAN: TO INSURE SCORING ACCURACY PRINT OUT THE
MEASURE TO INSURE THE ITEM LINES ARE 10 CM IN LENGTH. ALTER THE
FORM UNTIL THE LINES PRINT THE CORRECT LENGTH. THEN ERASE THIS
MESSAGE.
Individually
(Personal well-being)
I----------------------------------------------------------------------I
Interpersonally
(Family, close relationships)
I----------------------------------------------------------------------I
Socially
(Work, school, friendships)
I----------------------------------------------------------------------I
Overall
(General sense of well-being)
I----------------------------------------------------------------------I

Session Rating Scale (SRS)
This scale is for illustration purposes only. The actual scale, which includes 10-centimeter
lines for each item, may be downloaded from http://www.scottdmiller.com. Adapted from
Guterman (2013) and used with permission of Scott D. Miller (http://www.scottdmiller.com).
Name ________________________Age (Years):____ Sex: M / F
Session # ____ Date: ________________________
Who is filling out this form? Please check one: Self_______ Other_______
If other, what is your relationship to this person? ____________________________
Please rate today’s session by placing a mark on the line nearest to the description that best
fits your experience.
Relationship
I-------------------------------------------------------------------------I
Goals and Topics
I------------------------------------------------------------------------I
Approach or Method
I-------------------------------------------------------------------------I
Overall
I------------------------------------------------------------------------I
I felt heard,
understood, and
respected.
I did not feel
heard,
understood, and
respected.
We worked on
and talked
about what I
wanted to
work on and
talk about.
We did not
work on or
talk about
what I wanted
to work on and
talk about.
Overall,
today’s session
was right for
me.
There was
something
missing in the
session today.
The therapist’s
approach is a
good fit for
me.
The therapist’s
approach is
not a good fit
for me.

Child Outcome Rating Scale (CORS)
This scale is for illustration purposes only. The actual scale may be downloaded from
http://www.scottdmiller.com. Adapted from Guterman (2013) and used with permission of
Scott D. Miller (http://www.scottdmiller.com).
Name ________________________Age (Years):____
Sex: M / F_________
Session # ____ Date: ________________________
Who is filling out this form? Please check one: Child_______ Caretaker_______
If caretaker, what is your relationship to this child? ____________________________
How are you doing? How are things going in your life? Please make a mark on the scale to
let us know. The closer to the smiley face, the better things are. The closer to the frowny
face, things are not so good. If you are a caretaker filling out this form, please fill out
according to how you think the child is doing.
Me
(How am I doing?)
I------------------------------------------------------------------------------------I
Family
(How are things in my family?)
I------------------------------------------------------------------------------------I
School
(How am I doing at school?)
I------------------------------------------------------------------------------------I
Everything
(How is everything going?)
I------------------------------------------------------------------------------------I

Child Session Rating Scale (CSRS)
Name ________________________Age (Years):____
Sex: M / F_________
Session # ____ Date: ________________________
How was our time together today? Please put a mark on the lines below to let us know how
you feel.
Listening
I-----------------------------------------------------------------------------------I
How Important
I-----------------------------------------------------------------------------------I
What We Did
I-----------------------------------------------------------------------------------I
Overall
I-----------------------------------------------------------------------------------I
The therapist
listened to me.
The
therapist did
not always
listen to me.
What we did
and talked
about were
important to
me.
What we did
and talked
about was not
really that
important to
me.
I hope we do
the same kind
of things next
time.
I wish we
could do
something
different.
I liked what
we did today.
I did not
like what
we did
today.

Young Child Outcome Rating Scale (YCORS)
Name ________________________Age (Years):____
Sex: M / F_________
Session # ____ Date: ________________________
Choose one of the faces that shows how things are going for you. Or, you can draw one
below that is just right for you.

Young Child Session Rating Scale (YCSRS)
Name ________________________Age (Years):____
Sex: M / F_________
Session # ____ Date: ________________________
Choose one of the faces that shows how things are going for you. Or, you can draw one
below that is just right for you.

Suggestions and Considerations for
Using Rating Scales and Client Feedback
1. Introduce the rating scales to clients by describing their purposes in clear and simple
language.
2. Openly discuss the ratings with clients, and be prepared to take the ratings seriously,
but not personally.
3. Adapt and revise counseling sessions based on the ratings and feedback received from
clients.
4. Adjustments based on rating scales and client feedback may reduce the likelihood of
drop outs and thereby improve treatment outcomes.
5. When clients have difficulty reading or are otherwise unable to understand the rating
scales, especially children, counselors should consider explaining the rating scales to
clients.

References and Suggested Readings
American Counseling Association. (2014). Code of ethics. Alexandria, Virginia: Author.
American Psychiatric Association. (1952). Diagnostic and statistical manual of mental
disorders. Washington, DC: Author.
disorders (2nd
edition). Washington, DC: Author.
disorders (3rd
disorders (3rd
edition, revised). Washington, DC: Author.
disorders (4th
disorders (4th
edition, text revision). Washington, DC: Author.
disorders (5th
Anderson, H., & Goolishian, H.A. (1988). Human systems as linguistic systems: Preliminary
and evolving ideas about the implications for clinical theory. Family Process, 27,
371-393.
Berger, P., & Luckmann, T. (1967). The social construction of reality. Garden City, NY:
Doubleday.
de Shazer, S. (1982). Patterns of brief family therapy. New York: Norton.
de Shazer, S. (1984). The death of resistance. Family Process, 23, 11-17.
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.
de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.
de Shazer, S. (1991). Putting difference to work. New York: Norton.
de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar E., Gingerich, K., & Weiner-
Davis, M. (1986). Brief therapy: Focused solution development. Family Process, 25,
207-222.
Derrida, J. (1967). Of grammatology (G. C. Spivak, Trans.). Baltimore, MD: The John
Hopkins University Press.
Duncan, B. (2014). On becoming a better therapist: Evidence based practice one client at a
time. (2nd
edition). Washington DC: American Psychological Association
Duncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003a). Young child outcome rating
scale. Chicago: Author.
Duncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003b). Young child session rating
scale. Chicago: Author.
Duncan. B.L., Miller, S.D., & Sparks, J. (2003). Child outcome rating scale. Chicago:
Author.
Duncan. B.L., Miller, S.D., & Sparks, J.A. (2004). The heroic client: A revolutionary way to
improve effectiveness through client-directed, outcome-informed therapy. San
Francisco: Jossey-Bass.
Duncan, B.L., Miller, S.D., Sparks, J.A., & Johnson, L.D. (2003). Child session rating scale.
Fort Lauderdale, FL: Author.
El-Hai, J. (2005). The lobotomist: A maverick medical genius and his tragic quest to rid the

world of mental illness. Hoboken, NJ: Wiley & Sons.
Frances, A. (2012, October 30). DSM5 field trials discredit APA. Psychology Today.
Retrieved on February 21, 2015 from https://www.psychologytoday.com/blog/dsm5-
in-distress/201210/dsm-5-field-trials-discredit-apa
Franklin, C., Trepper, T.S., McCollum, E.E., & Gingerich, W.J. (2011). Solution-focused
brief therapy: A handbook of evidence-based practice. New York: Oxford University
Press.
Gergen, K.J. (2009). An invitation to social construction (2nd ed.). Thousand Oaks, CA:
Sage.
Guterman, J. T. (1994). A social constructionist position for mental health counseling.
Guterman, J.T. (1996). Doing mental health counseling: A social constructionist re-vision.
Guterman, J.T. (1998). Identifying pretreatment change before the first session. Journal of
Mental Health Counseling, 20, 370-374.
Guterman, J.T. (2013). Mastering the art of solution-focused counseling (2nd
edition)
Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious
and spiritual concerns. Counseling and Values, 51, 39-52.
Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine
headache. The Family Journal: Counseling and Therapy for Couples and Families,
13, 195-198.
Guterman, J.T., & Schildbach, J. (2014, June). The stigma of mental illness and the noble
savage. Counseling Today, pp. 60-63.
Held, B.S., (1992). The problem of strategy within the systemic therapies. Journal of Marital
and Family Therapy, 18, 25-35.
Johnson, L.D., Miller, S.D., & Duncan, B.L. (2000). Session rating scale 3.0. Chicago:
Author.
Lambert, M.J. (1992). Implications of outcome research for psychotherapy. In J.C. Norcross
M.R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New
York: Basic Books.
Lambert, M.J., Whipple, J., Smart, D., Vermeersch, D., Nielsen, S., & Hawkins, E. (2001).
The effects of providing therapists with feedback on patient progress during
psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11, 49-46.
Lipchik, E. (2002). Beyond technique in solution-focused therapy: Working with emotions
and the therapeutic relationship. New York: Guilford.
Martin, C.V., Guterman, J. T., & & Shatz, K. (2012). Solution-focused counseling for eating
disorders. VISTAS, 1-11.
Miller, S., & Duncan. B.L. (2000). Outcome rating scale. Chicago: Author.
Molnar A., & de Shazer, S. (1987). Solution-focused therapy: Toward the identification of
therapeutic tasks. Journal of Marital and Family Therapy, 13, 349-358.
Murphy, J.J. (2008). Solution-focused counseling in middle and high schools (2nd
ed.)
O'Hanlon, B., & Rowan, T. (2003). Solution oriented therapy for chronic and severe mental
illness. New York: Norton.
O'Hanlon, W. H., & Weiner-Davis, M. (1989). In search of solutions: A new direction in

psychotherapy. New York: Norton.
White. M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.

Suggested Internet Resources
Jeffrey T. Guterman, Ph.D.
PowerPoint for this Institute is available at http://JeffreyGuterman.com
Twitter: http://twitter.com/JeffreyGuterman
Facebook: http://facebook.com/jeffreygutermanpage
Institute for Solution-Focused Therapy
http://www.solutionfocused.net
International Center for Clinical Excellence (ICCE)
http://www.centerforclinicalexcellence.com
National Institute of Mental Health (NIMH): Research Domain Criteria (RDoC)
http://www.nimh.nih.gov/research-priorities/rdoc/index.shtml
Scott D. Miller, Ph.D.
http://www.scottdmiller.com
Solution-Focused Brief Therapy Association (SFBTA)
http://www.sfbta.org

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