Clients With Serious Mental Health Issues

With the changes that have occurred in the 21st century, including the impact of managed care and the effects of legislation on health care, more and more the field of counseling has focused on the formal diagnosis of clients (Seligman, 2004). A social constructionist viewpoint such as Adler's theory is one method counselors can use to diagnose clients. Adler (1927/1946, 1924/1959) preferred the term discouraged as opposed to pathological, mentally sick, or using a label of sickness when referring to an individual. He believed that psychological disturbances or neuroses occur because of an exaggerated inferiority feeling or an insufficiently developed feeling of community. Under these two circumstances, a person may experience or anticipate failure in situations that seem unattainable and become discouraged. When an individual is discouraged, he or she first resorts to fictional means to relieve or mask – rather than overcome – inferiority feelings, attempting to bolster feelings of self. Eventually, private views clash with reality and create difficulties in work, friendships, or love relationships, which may lead to the development of psychological disturbances and symptoms. Symptoms such as anxiety, phobias, or depression are not Adler's main focus in understanding psychological difficulties, but he did believe that an individual's use of symptoms was important.

From an Adlerian viewpoint, three factors distinguish mild psychological disorders from severe disorders: depth of inferiority feelings, lack of feeling of community, and height of final goal (Way, 1950). The role of the counselor is not to treat mental diseases but to discover the fictions in a lifestyle and, thus, lead a client to greater growth and social interest. Counselors assume a nonpathological perspective.

Even though Adler was not a proponent of diagnosis, today's managed care has affected the counseling field, requiring most counselors to use diagnosis and the Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision; American Psychiatric Association, 2000). Seligman (2004) stated that individual psychology "seems most appropriate for people who are experiencing long-standing emotional difficulties and who are having difficulty developing self-confidence, mobilizing themselves, and finding a rewarding direchon" (p. 196). Diagnoses that might suit individual psychology include disorders of childhood and adolescence (oppositional defiant disorder, separation disorder), depression or anxiety (dysthymic disorder, generalized anxiety disorder, or social phobia), and other disorders such as child or adolescent antisocial behaviors or relationships or occupational problems. Seligman also noted that with the push by managed care, counselors need to be flexible in using counseling skills and aligning counseling techniques with a client's diagnosis as well as using a multidisciplinary focus that will most benefit clients. Seligman shared Adler's viewpoint that clients are unique, necessitating the match between counseling techniques and individual clients.

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