New Paper by Villanova Counseling Professors Suggests Client-Centered Shifts in Diagnostic Models

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guidebook so embedded into the US healthcare system that all mental health professionals—from counselors to social workers—must assign clients a DSM-generated diagnosis in order to receive reimbursement for their services. A new paper by Villanova professors Krista Malott, PhD, and Terence Yee, PhD, along with a colleague from New Zealand, critically evaluates this model.

“We suggest a paradigm change in the fundamental way to approach and support people in their efforts to achieve health, wellness, and a sense of justice, dignity and worth,” says Dr. Malott.

In their paper, published in the International Journal for the Advancement of Counseling, the authors identify key flaws of the DSM model and process, particularly in regard to the embeddedness of assumptions regarding "normal" and "pathological" that fail to take into account the broad diversity of human norms, cultures and life experiences. Consequently, diagnosis, and related mental health interventions, can erase, stigmatize and marginalize those whose identities or traits lie outside the dominant groups or norms. Instead, Drs. Malott and Yee propose a client-centered support model.

“We are suggesting a decentering. Instead of the traditional perspective where the mental health specialist is at the center as expert within a pathology and medical framing of distress, the client voice and need become the center,” says Dr. Malott.

Current and future development of this theoretical piece include inviting dialogue within and across the field, both in national and international settings, as well as through implementation of a study exploring the decolonizing practices of current mental health educators nation-wide.

Learn more about Villanova's graduate programs in Counseling.