Social Justice Solutions Inc. wanted to know what Social Workers had to say about the use of the DSM in practice, and how they felt about the changes taking place in the DSM-V. Several individuals agreed to participate in a brief interview and this is the first in that series.
Interviewed here is Dr. Joanne Cacciatore, PhD, FT, who was quoted by Psychology Today back in April 2012 regarding her thoughts on the then proposed changes to the DSM-V. Dr. Cacciatore has been influential in opposing the chances, and was involved in development of the boycotting of the DSM-V petition. Dr. Cacciatore is also the Founder and Chairman of the MISS Foundation. Here is what Dr. Cacciatore has to say:
Social Justice Solutions (SJS): Thank you for agreeing to this interview Dr. Cacciatore. We are truly happy to be sharing with our readers what their fellow professionals have to say about the DSM in general, and the new DSM-Changes. Can you tell us a bit more about your experiences as a social worker?
Dr. Cacciatore: I have worked with families whose babies and children have died or are dying since 1996. It’s truly a tragic privilege to do this work. I’m also a tenure track professor at ASU (Arizona State University) where I study traumatic death and direct the graduate Certificate in Trauma and Bereavement program. My research focuses on the deaths of babies, children, and traumatic death. I examine epidemiological and etiological factors, rituals and coping, psychosocial intervention in acute care and in the therapeutic relationship, long term individual and familial effects, and policy.
SJS: And how often would you say you use the DSM in your practice?
Dr. Cacciatore: Never. I do supportive counseling for mourners, and I do not diagnose serious mental illness.
SJS: Okay, that’s good to know. Now, in your opinion what is the biggest flaw with the new DSM-V?
Dr. Cacciatore: The fact that instead of expanding the bereavement exclusion from two months back to one year, as it was in the DSM III and wherein the kappas for reliability are much more robust, they removed it making the DSM-5 less reliable and valid than the DSM IV. Thus, using the DSM5 criteria, normal grief can be easily mistaken for Major Depressive Disorder only two weeks after the death. Now, I’m not a big fan of the DSM-IV standard of two months: we all know that, for example, traumatic grief endures much longer. However, instead of expanding the time frame back to the DSM-III guidelines, we’ve narrowed them, making false positives more likely, not less likely. This may result in a more heavy-handed approach to treating bereavement. I’ve written about this extensively on my blog (this post went viral) which began in March of 2012 here: http://drjoanne.blogspot.
SJS: I think you already alluded to this, but how will these changes influence the client population you work with specifically?
Dr. Cacciatore: My population is at significantly increased risk of false positive for Major Depressive Disorder and thus at risk for inappropriate and over-zealous medical treatment for a mental illness they may not have.
SJS: Okay, thank you for clarifying. Can you think of a more beneficial approach to diagnosis than the DSM?
Dr. Cacciatore: With my population, I find diagnoses generally irrelevant. I find that unconditional loving kindness, community, support groups, compassionate provider care, ritual, spirituality for some, exercise, sunshine, mindfulness training, and permission to grieve without rushing the other through grief are often most helpful. Social workers are trained to look at the person-in-environment. Perhaps, our approach should be more person focused and less attention should be given to the diagnosis.
SJS: Very true. What do you believe led the mental health professions to make such changes as those being suggested in the DMS-V?
Dr. Cacciatore: Overall, mental health professionals are very focused on the medical model. I believe that social workers need to focus on that which we are trained to do: extend civic love and compassion to the client, staring where he or she is. We are not wed to the medical model; social work is ecological, psychosocial, and systems oriented. The lens through which we see existential struggle and suffering should be our own, not one created by psychiatry.
SJS: So, with that in mind where do you believe the field of mental health will go from here, and what role can social workers play in moving the field forward?
Dr. Cacciatore: I think we are at a crisis, a crucial moment of paradigm shift, as Thomas Kuhn said. And it’s a very exciting period as psychiatrists, psychologists, social workers, and spiritual leaders join together to speak out against the pathologization of normal human emotion and behavior. Social workers do have options. Some have decided to utilize the ICD, and some have decried the use of a nomenclatural system, foregoing insurance companies and enacting a sliding scale fee for service. Much depends on the individual social worker’s working environment/agency. If the DSM offends your humanity, then pause before you buy and give it thought. Remembering who you are and why you became a social worker.
SJS: Very good advice for all the social workers out there. Thank you so much for your time, and for your dedication to your clients and the field of social work!
If you are interested in finding out more about Dr Cacciatore’s work you can visit the following links:
Organizational Website- http://www.missfoundation.org/
Written By Georgianna Dolan-Reilly, LMSW
SJS Staff Writer
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