Part Four
Future Changes and Practice Implications for Counselors

Part Four Introduction

In Part Four, we cover personality disorders, highlighting an emerging model of practice to diagnose personality conditions as well as practice implications for counselors using the DSM-5. In Chapter 16, Looking Ahead: Personality Disorders, we provide a brief description of each personality disorder and focus the rest of the chapter on a hybrid model of personality disorders proposed for the future. Although we recognize that counselors frequently work with personality dysfunction, we decided to place this chapter at the end of this book because only semantic changes to the diagnostic criteria in the DSM-IV-TR (APA, 2000) were made in the DSM-5 (APA, 2013a). Instead we focus on future changes, which we estimate will significantly modify the way counselors conceptualize and diagnose personality disorders.

In the final chapter, Practice Implications for Counselors, we continue looking ahead but with a focus on clinical practice. This chapter includes philosophical implications for switching from the DSM-IV-TR to the DSM-5 and a detailed discussion of technical considerations, such as how to use other specified and unspecified diagnoses; coding and recording modifications; future changes to coding and recording; and newly available diagnostic assessment and screening tools, including the WHODAS 2.0 (WHO, 2010) and the Cultural Formulation Interview (APA, 2013a). We also describe the potential future direction of diagnostic nosology.

We conclude this section, and this Learning Companion, with a sense of urgency for counselors to become advocates for appropriate and empirically based uses of diagnostic nomenclature. We urge counseling professionals to become stewards of diagnostic research, participate in field trials and public comment periods, and have a seat at the table during upcoming modifications to both the DSM and ICD, as well as other proposed diagnostic formulations such as the Research Domain Criteria project launched by the NIMH (for more information, see Insel et al., 2010; Sanislow et al., 2010). Regardless of the platform, counselors need to find their voice within the future of diagnostic nomenclature so our profession can have a stronger foothold in these discussions.