Tag Archives: School Counselors

The Dialectics of Diagnosis at MFPE in Belgrade

Waving

Today I’m in Bozeman on my way to present to the Montana School Counselors in Belgrade, MT. As my friends at the Big Sky Youth Empowerment Program like to say, “I’m stoked!” I’m stoked because there’s hardly anything much better than spending a day with Montana School Counselors. Woohoo!

My topic tomorrow is “Strategies for Supporting Students with Common Mental Health Conditions.” That means I’ll be reviewing some DSM/ICD diagnostic criteria and that brings me to reflect on the following. . . .

Not long ago (July, 2019), Allsopp, Read, Corcoran, & Kinderman published an article in Psychiatry Research, not so boldly titled, “Heterogeneity in psychiatric diagnostic classification.” Hmm, sounds fascinating (not!).

A few days later, a summary of the article appeared in the less academically and more media oriented, ScienceDaily. The ScienceDaily’s contrasting and much bolder title was, “Psychiatric diagnosis ‘scientifically meaningless.” Wow!

The ScienceDaily summary took the issue even further. They wrote: “A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.”

Did you catch that? Scientifically worthless!

In an interview with ScienceDaily, Allsopp, Read, and Kinderman stoked the passion, and avoided any word-mincing.

Dr. Kate Allsopp said, “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”

Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”

Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”

In contrast to the authors’ conclusions, nearly every conventional psychiatrist believes the opposite–and emphasizes that psychiatric diagnosis is of great scientific and medical importance. For example, the Midtown Psychiatry and TMS Center website says, “A correct diagnosis helps the psychiatrist formulate the most effective treatment that will result in remission.”

No doubt there.

In addition, although I literally love that Allsopp, Read, and Kinderman are so outspoken about the potential deleterious effects of diagnosis, I think maybe they take it too far. For example, “Shall we pretend that we should provide the same intervention for panic attacks as we provide for conduct disorder, autism spectrum disorder, and gender dysphoria?”

That’s me talking now . . . and as I discussed this with Rita, she amplified that, of course, if you have a student who’s intentionally engaging in violent acts that harm others, we’re not treating them the same as a student who’s suffering panic attacks. Obviously.

Psychiatric diagnosis is a great example of a dialectic. Yes, in some ways it’s meaningless and overblown. And yes, in some ways it provides crucial information that informs our treatment approaches.

This leads me to my final point, and to my handouts.

What’s our School Counseling take-away message?

Let’s keep the baby and throw out with the bathwater.

Let’s de-emphasize labels – because labelling, whether accurate or inaccurate and whether self-inflicted or other inflicted, are possibly pathology-inducing.

Instead, let’s focus on specific behavior patterns, as well as abilities, impairments, stressors, and trauma experiences that interfere with academic achievement, personal and social functioning, and career potential.

In case you’re interested in more on this. My handouts for the workshop are below.

The Powerpoints: MFPE 2019 Belgrade Final

Managing fear and anxiety:Childhood Fears Rev

Student de-escalation tips: De-escalation Handout REV

Why Kids Lie and What to Do About It

 

 

Tough Kids, Cool Counseling PowerPoints from SDMHCA May 1 Workshop

Attached to this post are the handouts from the May 1 “Tough Kids, Cool Counseling” workshop in Spearfish, South Dakota.

It was a great day with about 85 wonderful, amazing, and exceptionally nice school and mental health counselors from throughout South Dakota.

This is the powerpoint:

SDMHCA Workshop 14 Part No Cartoons

And this is the supplementary handout:

SDMHCA TKCC Part II Supplement

I hope this information is helpful!

John SF

 

The Long Road to Eagle Pass Texas

Hi.

I’m re-posting this because today, exactly one year since I made my long trek to Eagle Pass from Montana . . . I’m back again. The drive was just as long as before, but I’m back because the folks in the Eagle Pass School District are pretty darn fun to hang out with. And so here’s the original post from last year:

 

It’s a very long way from Missoula, Montana to Eagle Pass, Texas.

Just saying.

This epiphany swept over me after the early morning Missoula to Denver flight and after the Denver to San Antonio flight and right about when, after driving from San Antonio in a rental car for about an hour, I finally saw a green mileage sign that said: Eagle Pass – 95 miles. I just laughed out loud. And even though I was all by myself, I said, “It’s a long way from Missoula to Eagle Pass.” This is just a small taste of the profound thoughts I think while traveling alone.

But time and space are relative and so I entertained myself by listening to a radio station, en Espanol. Given that I have the Spanish vocabulary of a toddler, I was quite delighted with myself when I discerned that I’d tuned in to a Christian radio station. The repeated use of the words, palabra, familia, and Dios helped me make that revelation. I also monitored the temperature via my rental car thermometer and happily observed that the outside temperature never rose above 104 degrees during my drive from San Antonio to Eagle Pass.

I like to think of myself as navigationally skilled; then again, it’s also good to remind myself that denial is more than just a river in Egypt. What I did manage to efficiently find were the Texas road construction crews. Getting to my hotel was harder. I had planned to use my internet telephone GPS, which would have been a great idea had there been internet access in Eagle Pass. This prospect began dawning on me when I passed the sign saying: Eagle Pass, pop. 26,864. At that point it was still unclear to me exactly how the Eagle Pass School District (conveniently located on the Rio Grande River) decided to have me come from Montana to do a full-day Tough Kids, Cool Counseling workshop. But, given that I’d never been to Texas before and they happened to want to pay me and then they decided to purchase 45 copies of Tough Kids, Cool Counseling, I found myself faced with an offer I couldn’t refuse.

And so, I decided to engage in a bit of disoriented driving, while studiously avoiding the bridge to Mexico. I finally found a man from India at a random hotel, who spoke English in addition to Punjab and Spanish. He was kind enough to let me use his Internet because he’d never heard of the hotel I’d booked. Then, a few wrong turns later and following an episode where my rental car transformed itself from an automatic into a manual transmission, I finally made it to the bargain Microtel hotel where they obviously take the term “micro” very seriously. Staying there required that I change into my secret Ant-man identity, thereby shrinking my expectations for Internet access, pool length, fitness facilities, and room into the size of an ant while retaining the physical strength and intellectual functioning of an adult male (I should note that I intentionally selected this hotel because it’s relatively green and was happy with my choice, despite my lightly mocking tone). The good news was that Taco-Morales was right across the street and I got to experience some authentic fajitas and red rice at prices an ant could afford.

The next day, in a coffee-free state (there are no Starbucks in Eagle Pass), I found my way to the Eagle Pass Junior High library (home of the Eagles—what a surprising team name!). That was when I discovered how they’d chosen me as their School Counseling Workshop leader. As it turns out, Montana Street is just a block or two from Eagle Pass Junior High and so they had apparently thought I lived right there ON Montana Street (and not IN the State of Montana). . . which is probably why they chose to pay me a flat rate and let me cover my own travel.

But very soon I discovered everything wonderful about Eagle Pass. I got to spend the day with Mr. Salinas, Ms. Gutierrez, Mr. Lopez, Connie, Karla, Luis, Toyoko, three women named Dora, and just enough School Counselors to scoop up 45 copies of Tough Kids, Cool Counseling. This was a group with immense compassion and dedication to making the lives of their students better. They teased me, laughed at my jokes, gently corrected my Spanish mis-pronunciations, asked for me to sign their books, and treated me with mucho mas respeto than I could ever deserve. By lunchtime they began talking about when I’d come back (I gently suggested January instead of August for my next visit). After lunch, Luis beat me at the Hand-Pushing game (I was depleted and distracted from all the energy it took to keep intermittently changing into an ant-sized person to fit into my hotel). However, one of the three Doras made an excellent volunteer for my mental set riddles (thank you Dora, for demonstrating in front of your peers that, in fact, learning can happen).

In the end, I return from Eagle Pass with renewed and sustained faith and hope in the human race. The big hearts and amazing dedication of the Eagle Pass School Counselors was inspiring. Thank-you Eagle Pass, for helping to expand my world. . . while simultaneously shrinking my expectations for hotel accommodations.