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Trauma survivors are a unique population of clients that represent nearly 80% of clients at mental health clinics
and require specialized knowledge on behalf of counselors. Researchers and trauma theorists agree that, with
the exception of dissociative identity disorder, no other diagnostic condition in the history of the Diagnostic and
Statistical Manual of Mental Disorders (DSM) has created more controversy with respect to the boundaries of the
condition, diagnostic criteria, central assumptions and clinical utility than post-traumatic stress disorder. However,
this mutable conceptualization of trauma and its aftermath have considerable implications for counseling practice.
With the recently released ffth edition of the DSM (DSM-5), the defnition of trauma and the diagnostic criteria for
post-traumatic stress disorder have changed considerably. This article highlights the changing conceptualization
of trauma and how the DSM-5 defnition impacts effective practices for assessing, conceptualizing and treating
traumatized clients.
Keywords: trauma, post-traumatic stress disorder, PTSD, DSM-5, diagnostic, clinical utility
Nearly 80% of clients seen in community mental health clinics have experienced at least one incident of
trauma during their lifetime, representing roughly fve out of every six clients (Breslau & Kessler, 2001). Over
the past 15 years, between increases in school and community violence in the United States and unrelenting
wars overseas, overt exposure to traumatic events has become an epidemic. Such events affect individuals
across the life span and precipitate numerous diagnoses within the Diagnostic and Statistical Manual of Mental
Disorders (DSM), most notably post-traumatic stress disorder (PTSD; Breslau & Kessler, 2001).
Survivors of trauma are a unique population of clients who require specialized knowledge and multifaceted
considerations on behalf of counselors (Briere & Scott, 2006). The Council for Accreditation of Counseling
and Related Educational Programs (CACREP) reiterates across both master’s and doctoral training levels the
importance of understanding the implications of trauma theory, research and practice in counselor preparation
and ultimately practice. CACREP (2009) standards incorporate trauma training within all eight core curricular
areas of demonstrated knowledge and within each core counseling track. Section II, Professional Identity, says
that counselors should understand the “effects of … trauma-causing events on persons of all ages” (CACREP,
2009, p. 10). However, even with the notable rates of trauma exposure, the deleterious outcomes faced by
survivors and the call for counselor training in this area, counselors report feeling unprepared to work with
survivors (Parker & Henfeld, 2012). Over 60% of practicing therapists reported wanting additional support and
education in their trauma work (Cook, Dinnen, Rehman, Bufka, & Courtois, 2011).
Trauma theorists agree that, with the exception of dissociative identity disorder, no other diagnostic condition
in the history of the DSM has created more controversy about boundaries of the condition, symptomatological
profle, central assumptions, clinical utility and prevalence than PTSD (Brewin, Lanius, Novac, Schnyder, &
The Professional Counselor
Volume 4, Issue 3, Pages 257–271
http://tpcjournal.nbcc.org
© 2014 NBCC, Inc. and Affiliates
doi:10.15241/lkj.4.3.257
Laura K. Jones, NCC, is an Assistant Professor at the University of Northern Colorado. Jenny L. Cureton, NCC, is a doctoral student at the
University of Northern Colorado. Correspondence can be addressed to Laura K. Jones, University of Northern Colorado, Department of
Applied Psychology and Counselor Education, Box 131, Greeley, CO 80639, laura.jones@unco.edu.
Laura K. Jones
Jenny L. Cureton
Trauma Redefined in the DSM-5: Rationale and
Implications for Counseling Practice