Behavioral Assessment as an Alternative to the DSM: Suggestions for Psychotherapists

Although the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision) is the cornerstone of mental health diagnosis in the United States and is usually the major approach to assessment taught in graduate programs, it has serious deficiencies. A functional diagnostic system is based on categories that are reliably distinct and valid, conveys some information about the likely etiologies of the condition, provides guidance for selecting research-supported treatments, and suggests a likely prognosis (future course of the disorder). The DSM classification scheme does not exhibit any of these features to a strong degree. Behavioral assessment is proposed and described as a replacement for the DSM. Instead of postulating the existence of speculative mental illnesses, behavioral assessment involves the psychotherapist working with the client to develop operational measures of the overt behaviors, feelings, thoughts, and potential psychological aspects of their dysfunctional actions in daily life. Behavioral assessment can be used in any form of psychotherapy, not simply behavior analysis. By replacing DSM diagnoses with behavioral assessment, therapists can become more effective in helping their clients. The DSM labels can be retained for pragmatic purposes, even while being aware of the vacuity of the entire DSM system.