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Family Diagnosis/DSM-IV

Continuous Improvement Options

If there is an inherent tension between family therapists and the current DSM-IV requirements, how can the tension be resolved? One option is to work within the DSM system to incorporate family assessment using the GARF and the CORD, as well as enhancement of Axis IV psychosocial stressor definitions. A unified effort will be required to achieve this goal in DSM-V. Another option is to develop a separate, parallel classification system. Several options are discussed in Florence Kaslow's (1996) Handbook of Relational Diagnosis and Dysfunctional Family Patterns. Perhaps a third option is for family therapists to abandon the use of diagnosing and participation in the current insurance and court testimony requirements (Becvar and Becvar 2000). Professionals could make a greater effort to educate insurance companies and courts about the efficiency of family therapy without diagnosis; some Employee Assistance Programs (EAP) accept this premise. If education were unsuccessful, moving away from payment by insurance and/or courts and accepting the financial risk of serving only self-paying clients would be a dramatic way for family therapists to make a statement consistent with systemic beliefs.

Bibliography

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders-Text Revision, 4th edition, rev. edition. Washington, DC: American Psychiatric Association.

Becvar, D. S., and Becvar, R. J. (2000). Family Therapy: A Systemic Integration, 4th edition. Boston: Allyn and Bacon.

Denton, W. H. (1989). "DSM-III-R and the Family Therapist: Ethical Considerations." Journal of Marital and Family Therapy 15(4):367–378.

Denton, W. H. (1990). "A Family Systems Analysis of DSM-III-R." Journal of Marital and Family Therapy 16(2):113–126.

Group for the Advancement of Psychiatry Committee on the Family. (1996). "Global Assessment of Relational Functioning Scale (GARF): I. Background and Rationale." Family Process 35(2):155–190.

Kaslow, F. W. (1993). "Relational Diagnosis: An Idea Whose Time Has Come?" Family Process 32( June):255–259.

Kaslow, F. W., ed. (1996). Handbook of Relational Diagnosis and Dysfunctional Family Patterns. New York: Wiley.

Strong, T. (1993). "DSM-IV and Describing Problems in Family Therapy." Family Process 32( June):249–253.

World Health Organization. (1948) Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Sixth Revision of the International Lists of Diseases and Causes of Death. Geneva: Author.

Yingling, L. C.; Miller, W. E.; McDonald, A. L.; and Galewaler, S. T. (1998). GARF Assessment Sourcebook: Using the DSM-IV Global Assessment of Relational Functioning. Philadelphia: Brunner/Mazel.

LYNELLE C. YINGLING

Additional topics

Marriage and Family EncyclopediaFamily Theory & Types of FamiliesFamily Diagnosis/DSM-IV - Understanding The Dsm-iv Classification System, Garf Development, Family Therapy Theorists' Concerns About Using The Dsm Diagnosis System