Labels are used in assessment in two main ways. One is as a shorthand term to refer to specific behaviors. The term hyperactive may refer to the fact that a student often gets out of his seat and talks out of turn in class. A counselor may use "hyperactive" as a summary term to refer to these behaviors. Labels are also used as a diagnostic category which is supposed to offer guidelines for knowing what to do about a problem. Here, a label connotes more than a cluster of behaviors. It involves additional assumptions about the person labeled which should be of "diagnostic" value. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association describes hundreds of terms used to describe various disorders. [See DSM-IV.]
Methodological and conceptual problems connected with the use of diagnostic categories include lack of agreement about what label to assign clients and lack of association between a diagnosis and indications of what intervention will be effective. Psychiatric labels have been criticized for being imprecise (saying too little about positive attributes, potential for change, and change that does occur, and too much about presumed negative characteristics and limits to change). Both traits and diagnostic labels offer little detail about what people do in specific situations and what specific circumstances influence behavior. There is no evidence that traits have dispositional properties. Little cross-situational consistency has been found in relation to "personality traits." Some behaviors may appear "trait-like" in that they are similar over time and situations because of similar contingencies of reinforcement. Degree of consistency should be empirically explored for particular classes of clients and behavior rather than assumed. Acceptance of a label may prematurely close off consideration of promising options. The tendency to use a binary classification system (people are labeled as either having or not having something, for example, as being an alcoholic or not), may obscure the varied individual patterns that may be referred to by a term. Critics of the DSM highlight the consensual nature of what is included (reliance on agreement rather than empirical criteria) and the role
Clinical Assessment of economic considerations in its creation. Some argue that psychiatric classification systems encourage blaming victims for their plights rather than altering the social circumstances responsible for problems.
Labels that are instrumental (they point to effective interventions) are helpful. For example, the understanding of anxiety disorders has advanced requiring the differential diagnosis among different categories (simple phobia, generalized anxiety, panic attacks and agoraphobia). Failure to use labels that are indeed informative may prevent clients from receiving appropriate intervention. Labels can normalize client concerns. Parents who have been struggling to understand why their child is developmentally slow may view themselves as failures. Recognition that their child has a specific kind of developmental disability that accounts for this can be a relief.
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