Diagnoses, Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy

• Author: Tom Strong
• DOI: http://doi.org/10.1111/famp.12140
• Date: 01 September 2015
• Published date: 01 September 2015

Diagnoses, Relational Processes and Resourceful

Dialogs: Tensions for Families and Family Therapy

TOM STRONG*

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),

given its psychiatric focus on mental disorders in individuals, presents families and family

therapists with challenges. Despite considerable controversies over its adoption, the DSM-5

extends a process of standardizing a language for human and relational concerns. No

longer a diagnostic language of professionals alone, its use is medicalizing how mental

health funders and administrators, as well as clients, respond to human concerns. For

family therapists who practice systemically, particularly from poststructuralist and

strengths-based orientations, many tensions can follow when use of the DSM-5 is expected

by mental health administrators and funders, or by clients who present concern s about

themselves or a diagnosed family member. In this paper, I explore how such DSM-5 related

tensions might be recognized, navigated, and negotiated in the practice of family therapy

with clients, and with administrators and funders.

Keywords: Psychiatric Diagnoses; Couple and Family Therapy; Conversational Practice

Fam Proc 54:518–532, 2015

Language lives only in the dialogic interaction of those who make use of it. (Bakhtin, 1984,

p. 183)

Atherapeutic culture (Furedi, 2004; Illouz, 2008) has developed, enabled by self-help

media, celebrity testimonials, and a concerned public clamoring for expert knowledge.

Prior to ever seeing a family therapist, clients have often been busy at work making sense

of their concerns, using the expert or plausible languages accessible to them, language

that is seldom benign in its effects. Mental health professionals, including family thera-

pists, are considered experts at this kind of sense-making, which typically involves using

the psychiatric vocabulary and orientation of the Diagnostic and Statistical Manual of

Mental Disorders—Fifth Edition (hereafter DSM-5; American Psychiatric Association,

2013). This symptom-focused way of sense-making, or discourse, is increasingly expected

in funded therapy conversations.

Prior to the DSM-5 ’s publication, conflicts were rife within and across the helping

professions (e.g., Greenberg, 2013), with the Chairs of both DSM-IV and DSM-III coming

out strongly against the scientific process and outcomesthat went into the DSM-5 (Frances,

2013). Worse, the National Institute of Mental Health withdrew its support for publicly

funded research using DSM-5’s diagnoses just days before its publication (Insel, 2013).

*Werklund School of Education, University of Calgary, Calgary, AB, Canada.

Correspondence concerning this article should be addressed to Tom Strong, Werklund School of Educa-

tion, University of Calgary, 1302, *844 Education Tower, Calgary, AB, Canada T2N 1N4. E-mail:

strongt@ucalgary.ca.

518

Family Process, Vol. 54, No. 3, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12140