Assessment and Diagnosis in Action

Abstract

The book’s final chapter reiterates the key point that all knowledge is partial, provisional, and subject to review as new evidence comes to light. Thus, to guard against tunnel vision and premature closure, clinicians need to avail themselves of many forms of knowledge, from many domains, that can complement psychiatric categories and offer essential insight for understanding a client’s suffering and illuminating pathways for recovery. A discussion of the role and use of the DSM in real-world practice draws on both research and theory to highlight its benefits and limitations, including the challenges of distinguishing primary and secondary conditions, and of responding to subthreshold presentations. The chapter then provides a comprehensive overview of multiple ways of collecting, organizing, and interpreting information—biological, social, psychological, and spiritual—within a framework of therapist–client collaboration. Emergent integrative directions in clinical assessment are reviewed (epigenetics, diathesis–stress theory, the transdiagnostic model, etc.) that consider people in flexible relationship to elements of their environment and suggest how specific aspects of environment can contribute to mental disorder, a connection that has been lacking in previous theoretical models. The chapter concludes with a call for social workers to face the challenge of insuring that culture, spirituality, and the impact of poverty and oppression are not forgotten and that the idea of internal flaw, failure, and deficit does not overwhelm and obscure our commitment to social justice. Our ability to respond to this challenge rests on how well the next generation is taught to think critically, compassionately, and holistically—the very aim of this book.