The world of the Counselor An introduction to the counseling profession 5e chapter 10

324  You can’t have one without the other abnormal behavior, diagnosis, and medication  If you believe in extreme deviations from the norm mental disorders and abnormal behavior, then

Abnormal Development, Diagnosis, &

Psychopharmacology

 Read vignettes, middle of p 323

 Reasons to study abnormal developmental,

diagnosis, & medication—see 11 reasons p 324

 You can’t have one without the other (abnormal

behavior, diagnosis, and medication)

 If you believe in extreme deviations from the norm (mental disorders and abnormal

behavior), then you are going to want to understand it—classify it

 If you classify it (diagnose disorders), then you (or the clients) are going to want to be treated

 Genetic and Biological Explanations

to treat them biologically

▪ Etc.

 Extremely poor parenting leads to development of

maladaptive behaviors as our defense mechanism

attempt to control the impulses of our id

 Discuss how various parenting styles may affect

development

▪ Parents who are obsessively strict

 Learning occurs through operant conditional, classical

 Born capable of multiple personality characteristics

 Behaviors and cognitions continually reinforced

 Reinforcements can be very complex and subtle

 Abnormal behavior result of reinforcement

 Analysis of reinforcements leads to understanding of

person

 New behaviors learned by applying principles of

learning

 Maslow and Rogers most influential

 Maslow: We exhibit characteristics based on our

placement in need hierarchy (See Figure 10.1, Page

332)

 Rogers: How significant others treat us results in our

personality development (and placement on Hierarchy)

 We all need to be loved

 Conditions or worth placed on us

 To gain love, we respond to others based on

conditions of worth—leads to false self

 With empathy, genuineness, and unconditional

positive regard we can rediscover our “true” selves

 Post-modernism

with others and how “reality” is passed down through society

▪ Perhaps, the mental health field plays a part in continuing this deception

 See Comparison of Models Table 10.1 Page 336

 Today, many clinicians integrate the models

 Greek words: Dia (apart) and gnosis (to perceive or

know)

 DSM-I: 1952

 DSM-IV-TR: Five Axes

 Axis I: All Disorders Except Personality Disorders or Mental Retardation

 Axis II: Mental Retardation and Personality Disorders

 Axis III: General Medical Conditions

 Axis IV: Psychosocial/environmental Problems

 Axis V: Global Assessment of Functioning

 DSM-5 to come out in 2013

 Advantages and Disadvantages of DSM

 Offers information on:

 Disorder’s main features

 Subtypes and variation in client presentations

 Typical pattern, course, or progression of symptoms

 How to differentiate disorders

 See Table 10.2, Page 340

 Axis I includes all disorders except personality

disorders or mental retardation (in DSM-5, to be called Intellectual Disability)

 Axis II is personality disorders and mental

retardation

 Mental Disorders Due to A

General Medical Condition

 Adjustment Disorders

 *See pp 339-341 for descriptions

 Listed on Axis II because treatment has little or no effect.

 Mental retardation: Intellectual functioning significantly

below average

 Personality Disorders: Deeply ingrained, inflexible, enduring patterns of behavior

▪ Cluster A: odd or eccentric.

▪ Disorders: paranoid, schizoid, and schizotypal

▪ Cluster B: dramatic, emotional, overly sensitive, and erratic

▪ Disorders: antisocial, borderline, histrionic, and

narcissistic

▪ Cluster C: anxious and fearful

▪ Disorders: avoidant, dependent, and

obsessive-compulsive

 Axis III: General Medical Conditions

 Use ICD-9-CM for diagnosis

 List on Axes I or II also if cause of disorder

 Axis IV: Psychosocial and Environmental

Problems

 List on Axes I or II also if cause of disorder

 Axis V: Global Assessment of Functioning Scale

 See Table 10.3, p 343

 Example of Multiaxial Diagnosis

 Axis I 309.0 Adjustment Disorder with

Depressed Mood

 Axis II 301.82 Avoidant Personality Disorder

 Axis III No Diagnosis

 Axis IV Divorce

 Axis V GAF=60 (current); 75 (highest

in past year)

 Antipsychotics (neuroleptics)

 Today, three types: conventional, atypical, 2 nd generation

tardive dyskinesia, mood disorders, other

 Mood-Stabilizing Drugs (e.g., for bipolar disorder)

other

 Antidepressants

 1930s: amphetamiens

 1950s: MAOIs and Tricyclics

 More recently: SSRIs and atypical anti-depressants

 Anti-anxiety Medications

 1960s: Librium, Valium

 Later, more benzodiaspenes (Tranzene, Zanax, more

 Nonbenzodiaspeines: Buspar , Gepirone, Other

 For generalized anxiety disorder,

obsessive- Stimulants

 Later 1800s: Cocaine and amphetamines for diet aid, emotional disorders

 Today: Mostly used for ADHD

 Also used for narcolepsy

 Most common: Ritalin, Cylert, and Dexedrine

 Warning: All have side affects

 Many different drugs today exist

 Misdiagnosis of Minority Clients

 Symptomatology may vary as a function of culture

 Does DSM-IV-TR truly take into account affects

of oppressive society?

 Some say: DSM-IV-TR legitimizes the concept of

“disorder” thus making it acceptable to oppress those with the disorder

 DSM-IV-TRs attempt to address cross-cultural

possibly cause death .” (APA, 2000, p 900)

 Ethics Code:

relative to diagnosis

▪ Cultural Sensitivity: Be sensitive to how cultural background can affect the manner in which the client expresses self

▪ Historical and Social Prejudice: Counselors should understand and recognize that some groups have been misdiagnosed and pathologized

diagnosing if you think if making a diagnosis will harm client

 DSM-5 (probably, 2013)

 May collapse Axis I and Axis II

 Other?

 Challenging Abnormality and Diagnosis

 Some say mental illness is a normal response to a

stressful situation (e.g., Laing and Szasz)

 Glasser believes psychopathology is a client’s clumsy attempt at meeting his or her needs

 Challenging Abnormality and Diagnosing (Cont’d)

 Ivey and Ivey suggest diagnosis may be a normal

response to developmental issues (see Box 10.3, p 351)

 Corey: feasons why clinicians should be careful when

diagnosing (see bottom of p 350)

 Overdiagnosis of Mental Illness

 Because we have DSM, do we naturally overly

diagnose?

 See Box 10.4, p 352: On Being Sane in Insane Places

 Confinement Against One's Will

 Donaldson v O’Connor (1975): People can’t be held

against their will unless there is danger to self or others

 Today, usually need a hearing to have people confined against their will

 Dismissing Impaired Graduate Students

 Should we dismiss students at all?

 Should we view students from DSM?

 Should we take a developmental perspective and

assist students to strive toward wellness?

 ACA code suggests:

▪ Assist students in securing remedial assistance

▪ Seek professional consultation and document decision to dismiss or refer students

▪ Ensure students have recourse in a timely manner

to address issues of referral or dismissal