Family Diagnosis/DSM-IV

Because family therapists provide services for clients covered by insurance contracts, family therapy effectiveness is limited by the requirements of the insurance company to assign an individual diagnosis in order to be paid. In family therapy theory, a primary goal is to reframe the presenting individual symptom as a family system problem that takes the blame off the individual and creates a team approach for solving the problem. Placing an individual diagnosis on the insurance claim runs counter to successfully depathologizing and reframing the problem. If the family therapist tries to explain the reason for an individual diagnosis, the communication does not make logical sense to the client, thus creating dysfunctional communication in the therapist-client system. If an individual in the family does not meet criteria for an individual DSM diagnosis but the therapy will not be covered without a diagnosis, what is the therapist to do?

The courts are another payer requiring the use of DSM in order to be accepted as a professional. Scientific evidence is required to substantiate expert testimony in legal cases. The DSM system has the most scientific evidence of any classification system used. Thus, it is the preferred evidence resource in court.

Even if insurance companies and courts were enlightened about the efficiency of family therapy and accepted family functioning diagnoses as sufficient, many family therapists would see using a family diagnosis as unethical (Becvar and Becvar 2000; Denton 1989; Denton 1990; Strong 1993). According to the constructivist philosophy of family therapy, classifying human behavior is seen as limiting the possibilities for growth, and consequently harmful. Using a pathology-based medical model—such as the DSM—is even more limiting in effect. Another dilemma is the lack of consensus among family therapists on how to diagnose family functioning. One goal of the GARF development was to create a consensus in the field concerning an accepted model of family assessment.