Communicate with your Therapist about Pending Diagnostic Changes


Communicate with your Therapist about Pending Diagnostic Changes
Pending Mental Heal Diagnostic Changes in DSM 5 Could Effect Your Treatment and Insurance Coverage

It is very hard for me to accept that our country does not provide our citizens with universal health care. I write today to tell readers of a sad reality and warn those with coverage for mental health difficulties that there is change in the wind which will alter many diagnoses, and this change may well effect your coverage. With this in mind when you understand the proposed changes, you can discuss them with your mental health provider. If you will be negatively affected, you can lobby your elected officials, asking them not to allow these changes.

Here is what is going on: In this explanation, I will try to be as clear as possible about a confusing matter. Without boring you with long words and too many details, there is a tool that is the diagnostic Bible in the mental health field, which is called the DSM ( the Diagnostic and Statistical Manual of Mental Disorders).


In the upcoming 5th edition a long existing feud, largely not known outside of the mental health field, is taking place. Here’s why: Sadly, in the mental health field academics (who do the research) and clinicians (who see and treat the patients, many also doing research) rarely consult each other. The reasons why begin in education. Usually one trains to be either an academic (devoted to research) or a clinician (devoted to face-to-face patient care, often as said, complimenting this concentration with research). Once this choice is made, totally different approaches to achieving goals are learned. This is a very unfortunate reality, leading to discord and rivalry, as respectful interaction in these fields would benefit every person, every family, and every community.

As a clinician impacted by this lack of collaboration, I can share two brief examples:

Several years ago I published a paper in a highly respected peer reviewed journal identifying five invisible and malignant patterns of emotional abuse (Rage, Enmeshment, Rejection/Abandonment, Severe Neglect, and Extreme Overprotection and Overindulgence), demonstrating that without intervention they pass from generation to generation, destroying individuals and families. Emotional abuse is always present where there is physical and sexual violence, but this paper showed that it also exists independently, eroding hope and opportunity. Anecdotally, I have seen that these cycles often morph into physical and sexual violence as generations pass. However, I have been unable to engage anyone with the data to test if my observations hold up upon their research examination. If my observations were proven accurate in this way, clinicians could say to those who are emotionally abused that unless they work toward change their lives and those of their children, and their children, are at grave risk.

The second example of this discord involves a young teenage patient I treated, while she was still a minor. This lovely and talented artist was referred by a clinical psychiatrist at a teaching hospital. Within a few weeks it became clear that my patient’s mother was being destroyed by the life style her husband insisted upon, and that she used the "illness" of their daughter, to keep him from leaving her. What she did not realize is that her husband thrived on her pleas for kindness and involvement, her ongoing misery, and their daughter's "illness" --  and that he was determined to avoid divorce and subsequent pressure for a commitment to one of his other women.

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Article contributed by
Advanced Member

SaraKay Smullens


I look forward to your thoughts and sharing with you.

To be continued,

SaraKay Smullens, MSW, BCD, LCSW, ACSW, CFLE, CGP 

Location: Philadelphia, PA
Credentials: BCD, MSW
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