Counselor’s Turn Against DSM-5: Can APA Ignore 120,000 Users?
By Allen Frances, MD
November 17, 2011
The users’ revolt against DSM-5 marches on and just became a much, much bigger parade. There are 120,000 counselors in the US—more than 20% of all mental health professionals—and DSM-5 is integral to their daily work. The American Counseling Association DSM-5 Task Force, skillfully led by Dr Dayle Jones, has made a meticulous study of DSM-5 and is alarmed by many of its suggestions. The following open letter from the ACA president to the president of the American Psychiatric Association, quoted in full, was just posted. It nicely summarizes what is wrong with DSM-5 and recommends essential corrective actions. How long can DSM-5 afford to battle with its users?
Dear Dr. Oldham:
I am sending this letter on behalf of the American Counseling Association [ACA], the world’s largest association for professional counselors. There are 120,000 licensed professional counselors in the United States; as such, we represent the second largest group that routinely uses the DSM…
ACA appreciates the efforts of the American Psychiatric Association (APA) and the Task Force to update the manual according to new scientific evidence. However, professional counselors have voiced several concerns about the DSM-5 development process and they have reservations about many of the proposed revisions. We believe resolving these issues are critical to counselors’ continued confidence in the DSM as a tool for competent and ethical diagnosis of psychopathology. Our concerns focus on empirical evidence, dimensional and cross-cutting assessments, field trials, the definition of mental disorder, and transparency.
Empirical Evidence. While we appreciate APA’s commitment to quality research, counselors are concerned that a number of the DSM-5 proposals have little basis in empirical studies. A systematic and independent review of the research base is critical when revising diagnostic criteria. Unfortunately, guidelines for conducting evidence-based reviews (eg, Kendler et al., 2009) were not provided to work groups until approximately 18 months after revisions had begun. The rationales posted on the DSM-5 website provide either incomplete or insufficient empirical evidence to support many of the proposed revisions. Reportedly in response to this, the DSM-5 Task Force appointed a Scientific Review Committee (SRC) charged with reviewing the empirical evidence supporting the proposed revisions. While we strongly applaud this decision, we would like more information as to how the SRC will conduct their review so that those outside the process can be assured of the solidity of the empirical evidence behind the proposals.
Dimensional and Cross-Cutting Assessments…
Definition of Mental Disorder. The DSM-5 Task Force has proposed a new definition of mental disorder which includes, “A behavioral or psychological syndrome or pattern that occurs in an individual that reflects an underlying psychobiological dysfunction” [APA, 2011]. Using the term psychobiological implies that all mental disorders have an underlying biological component. Although advances in neuroscience have greatly enhanced our understanding of psychopathology, the current science does not fully support a biological connection for all mental disorders. We therefore request that the definition of mental disorder be amended to indicate that mental disorders may not have a biological component.
Transparency. Although the DSM-5 Task Force has described its development process as “open, transparent and free of bias”, all work group members were required to sign confidentiality agreements that prohibit them from divulging information about the DSM-5 process, even after it is published. Most problematic, the reports of the DSM-5 SRC are not available for public inspection, which is a violation of one of the most basic and vital tenets of science — open access to data and/or processes for independent evaluation and critique. Without full transparency and openness, counselors may have difficulty having confidence in and trusting the DSM-5…
In the case in point, the current DSM-5 Task Force represents a power base that has increasingly dominated psychiatry since the DSM-III revision in 1980. They have been dominant inside psychiatry, aided by the pharmaceutical industry, third party carriers, and the NIMH. They still assume that psychiatry dominates the mental health field as it did in former times. They think they can operate behind closed doors ["without full transparency and openness"], pronouncing a not widely-shared view ["all mental disorders have an underlying biological component"], without supporting evidence ["insufficient empirical evidence to support many of the proposed revisions"]. It ain’t going to happen. What the DSM-5 Task Force is trying to bring off is a power play little different from the misbehavior of psychiatry’s worst offenders during the recent Dark Ages when much of the scientific product of psychiatry was built on a carefully crafted mythology. The rest of the world knows about that now whether organized psychiatry wants to talk about it or not.
I don’t know the people on the DSM-5 Task Force, or much about them – whether many of them have been on Speaker’s Bureaus, Advisory Boards, or participated in the guest-author, ghost-writer scene. I don’t know about their ties to the pharmaceutical industry. I don’t know how many of them actually see mentally ill patients or mostly serve in administrative positions. I don’t know how many have made a palpable contributions to the body scientific. I don’t even know how they got chosen to be on their various Work Groups. In this case, one can forgo the usual investigative pathways because it doesn’t matter how the groups came together or who is in them, their proposed results and the way they’ve dealt with others speaks for itself. I doubt that many of the people on the DSM-5 Task Force are in the pockets if GSK, Eli Lilly, or Johnson & Johnson like the epidemic of Kellers, Biedermans, or Nemeroffs in the recent epoch, but they’re part of a culture of arrogance that’s been built up over those years and it shows
I also doubt that the groups opposing the DSM-5 in its projected format are particularly interested in unseating psychiatry. It’s not that kind of revolt. They need people to manage medications and the severe mental illnesses that are impervious to their own technologies. I’m sure Dr. Frances and Spitzer aren’t motivated to take over psychiatry, nor are the psychoanalysts, nor am I. And the medical doctors who are increasingly prescribing psychiatric drugs aren’t doing that because they want the business. They’re doing that because of the influence of the pharmaceutical and insurance industries, and the fact that many of the psychiatrists they send people to have forgotten what psychiatrists are there to do.
In alliance with:
°Division of Behavioral Neuroscience and Comparative Psychology [Division 6 of APA]
°Division of Developmental Psychology [Division 7 of APA],
°Division of Clinical Psychology [Division 12 of APA],
°Society of Counseling Psychology [Division 17 of APA]
°Society for Community Research and Action: Division of Community Psychology [Division 27 of APA],
°Division of Psychotherapy [Division 29 of APA],
°Society for the Psychology of Women [Division 35 of APA],
°Division of Psychoanalysis [Division 39 of APA],
°Psychologists in Independent Practice [Division 42 of APA]
°Society for the Psychological Study of Lesbian, Gay, Bisexual, and Transgender Issues [Division 44 of APA],
°Society for Group Psychology and Psychotherapy [Division 49 of APA],
°Society for the Psychological Study of Men & Masculinity [Division 51 of APA],
°Division of International Psychology [Division 52 of APA],
°Association for Counselor Education and Supervision [Division of the American Counseling Association]
°Association for Humanistic Counseling [Division of the American Counseling Association]
°The Association for Creativity in Counseling [ACC, Division of the American Counseling Association]
°Association for Adult Development and Aging [AADA, Division of the American Counseling Association],
°Counselors for Social Justice [Division of the American Counseling Association],
°American Rehabilitation Counseling Association [ARCA, Division of the American Counseling Association],
°The Association for Women in Psychology,
°The Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling [ALGBTIC]
°Society of Indian Psychologists
°National Latina/o Psychological Association
°The Society for Personality Assessment,
°The Society for Descriptive Psychology,
°The UK Council for Psychotherapy [UKCP],
°Association of Counseling Center Training Agencies,
°Psychologists for Social Responsibility,
°The Constructivist Psychology Network [CPN],
°The Taos Institute
°Psychoanalysis for Social Responsibility [Section IX of Division 39 of APA]
°American Counseling Association [ACA]