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CSP 618 Mental Health Recovery and the DSM: A Social Justice Perspective Instructor: Elizabeth Donahue-Marucheau, LCSW Email: [email protected] Office Location: EBA 401A Office Hours: By appointment on Monday and Tuesday Class Meeting Time/Location: M 4:00-6:40 EBA 412 Section Number: 02 Student Disability Services: www.sa.sdsu.edu/sds/index.html The syllabus is subject to change, if changes are made they will be posted in writing on blackboard. Rational: This course fulfills one of the 13 core content areas required by the California Board of Behavioral Sciences for a master’s or doctoral degree from an accredited or approved institution preparing students to sit for LPCC licensure. Course Description: This course is designed for LLPC students who want to develop their clinical skills and increase their knowledge of psychopathology. Students who provide services in a variety of settings in which clients with an array of problems may present. The ability to competently assess and diagnose a client’s mental disorder is an important component in the students skill sets. Accurately diagnosing a client’s a mental illness can positively change the course of his life, while overlooking a diagnosis or making an incorrect diagnosis may create insurmountable challenges for the client. Additionally, assigning an inaccurate diagnosis may also put the practitioner and agency at risk. The overall goal of the course is to increase the student’s knowledge of psychopathology and to increase the student’s ability to competently assess and diagnose mental disorders. Emphasis will be placed on increasing the student’s ability to accurately diagnose a range of mental disorders according to the DSM-5 criteria by having a solid foundation in completing a competency based assessment. Not all disorders listed in the DSM-5 will be covered in the course. The primary focus will be on the most common mental disorders. Completing a bio-psychosocial assessment and looking at the contributions of the environment, genetics, and the client’s history to the development of mental disorders will also be part of the curriculum. Therapeutic interventions will be incorporated however treatment is not a focus of the course. 1 Required Texts and Materials o o o American Psychiatric Association (2013). DSM – 5, American Psychiatric Publishing Hanson, Rick, Mendius, Richard (2009), Buddha’s Brain, New Harbinger Publications, Inc. Morrison, James, ( 2014), Diagnosis Made Easier DSM-5 Made Easy, Guilford Press OPTIONAL: o Gray, S.W., & Zide, M.R. (2012). Psychopathology: A Competency Based Assessment Model for Social Workers (3rd ed.) Belmont, CA: Thomson/Brooks/Cole o Maddux, J., & Winstead, A. (2012), Psychopathology, Foundations for a Contemporary Understanding, New York NY, Routledge Materials & Resources available on the Internet: National Institute of Mental Health: http://www.nimh.nih.gov/ Tool kits to support recovery: http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/about.asp National Registry of Evidence-based Programs and Practices (SAMHSA: http://www.nrepp.samhsa.gov/find.asp American Psychiatric Association, DSM 5: http://www.dsm5.org/Pages/Default.aspx http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures National Institute for the Clinical Application of Behavioral Medicine http://www.nicabm.com/ I will also be providing additional readings which will be posted on blackboard based on your evolving interests and our class discussions. Blackboard Account: All students are required to have a blackboard account. www.MySDSU.edu. Student Learning Outcomes Using a social justice, trauma and recovery-oriented approach, this course provides an overview of adult and child mental health issues with an emphasis on biopsychosocial assessment, diagnosis, use of the DSM-5, mental status exam, and the major diagnostic categories. Specific Learning Outcomes: By the end of this course, students will develop skills in: 1. Diagnostic interviewing across the life cycle. (CACREP II. K. 3. a., c.; 5. b.; Community Counseling Standard C. 4., 5.) 2. Diagnostic expertise utilizing the DSM-5 (CACREP II. K. 7. g., h.; Community Counseling Standard C. 4., 5.) 2 3. Understanding the impact of cultural factors such as socioeconomic status, ethnicity, religion/spirituality, and sexual orientation on validity and reliability of DSM diagnoses. (CACREP II. K. 7. f., i.; Community Counseling Standard C. 4., 5.) 4. Incorporating evidenced-based treatment and interventions in developing treatment plans for myriad of DSM diagnoses. (CACREP II. K. 7. g., h.; Community Counseling Standard C. 4., 5.) Alignment of Student Learning Objectives with State and National Standards: The learning objectives of this course were developed in accordance with Board of Behavioral Sciences, Statutes and Regulations relating to the practice of Professional Clinical Counseling (LPCC). Visit the following Website for a detailed listing of LPCC Statutes and Regulations: http://www.bbs.ca.gov/ Course Format and Teaching Methods This course will include a combination of adult learning styles with a focus on the three most cited styles: kinesthetic, auditory and Visual. Teaching methods will include but are not limited to: experiential interactive lectures, group discussions- apply by doing, small group presentations, role plays, videos, with the major focus of bridging research to practice through application. Course Assignments, Exams, and Participation: *******You will need two small blue books and one large blue book for your assignments. a. EXAM #1 - will cover topics discussed from week 1 – 5. The purpose of the exam is to determine if students have mastered material from the required readings and class lectures to achieve the learning outcomes of the course. The exam will cover the lectures and readings through week 5. Students are expected to study all assigned readings, whether or not they are discussed in class. In addition, questions will be taken from guest presenters and the corresponding readings for those sections. The questions on the exam will be in the format of clinical case vignettes, the student will be required to do a biopsychosocial assessment and come up with a diagnosis. In addition, students will need to apply the Polyvagal Theory to the client in the vignette demonstrating mastery of the subject matter. The exam must be taken on the date listed. If illness or other extenuating circumstances prevent students from taking the exam when it is scheduled, they should notify the instructor of the reasons preventing them from taking the exam. The instructor may negotiate another time for the student to take the exam. This exam addresses learning outcomes #1-3 above. b. INDIVIDUAL CAST STUDY (See Assignment section of Blackboard for details) The assignment is designed to provide the student with an opportunity to do an assessment using the competency based assessment model and to make a diagnosis for a client. The core 3 of the assignment is to match symptoms demonstrated by the client to diagnostic criteria contained in the DSM-5. The Individual Case Study assignment must be based on a client assigned in the student’s current field practicum placement. . If for any reason a student is not in a field placement or not assigned a case by the 3rd class, please notify the instructor. i. It is NOT appropriate and considered unethical to use a client system from any other agency, including students’ places of employment or agencies where they do volunteer work unless permission is obtained from the Instructor. ii. Informed consent. Students will be asked to sign a statement verifying that the client is in fact from a field placement or they have permission. A signed consent needs to be attached to the paper or a statement saying why this is not appropriate and your field supervisor will need to sign this. iii. Expectations for paper. Students are expected to write at a graduate level and produce clear, well-organized, professional papers, with correct grammar and spelling. Students should write their Case Study of a Client as if their paper were to be presented to professional counselors in the community. The paper should follow the stylistic guidelines suggested by the most recent edition of the APA manual. Information can be found at http://owl.english.purdue.edu/owl/resource/560/01/ Particular attention should be placed on APA guidelines regarding: a. the style of the manuscript; expression of ideas (e.g., writing style, grammar, and ways to reduce bias in language); b. format and content of the abstract; c. reference citations in the text; reference list; citation of Internet websites; margins; headings; and use of numbers. d. The assignment addresses Learning Outcomes #1-4 above. c. RESEARCH EVIDENCE BASED PRACTICE & CULTURE, PSYCHO-EDUCTION PROJECT (See Assignment section in Blackboard for details). The goal of this assignment is to provide the student with an opportunity to demonstrate his/her ability to research the latest data on various cultures, class and gender as it applies to a specific diagnosis. This assignment helps to decrease the stigma of mental illness and brings in a strength based approach. This assignment also give the student an opportunity to learn how to provide psycho- education to their clients on a specific DSM -5 Diagnosis and present an evidenced based practice treatment model. The assignment addresses Learning Outcomes #1-4 above. d. EXAM #2 4 The purpose of the exam is to determine if students have mastered material from the required readings and class lectures to achieve the learning outcomes of the course. The exam will cover the lectures, reading materials and expert guest lectures from week 6-14. Students are expected to study all assigned readings, whether or not they are discussed in class. In addition, questions will be taken from guest presenters, group projects and the corresponding readings for those sections. The questions on the exam will be in the format of diagnosing clinical case vignettes. The exam must be taken on the date listed. If illness or other extenuating circumstances prevent students from taking the exam when it is scheduled, they should notify the instructor of the reasons preventing them from taking the exam. The instructor may negotiate another time for the student to take the exam. This exam addresses learning outcomes #1-4 above. Course Policies: 1. Attendance. Students are expected to come to class on time, and stay for the entire class session. Students should notify the instructor in advance by email, if they need to miss class, arrive late, or leave early. The instructor will excuse absences resulting from verified unforeseen circumstances (e.g., illness, family emergency, unavoidable commitments). Vacations and other out of town activities will not be considered excused absences. Students may be excused from class to attend a professional workshop if the workshop applies directly to the course. In this case, the instructor expects that the student will briefly share with the class what was learned in the workshop. When students miss class, they must take responsibility for obtaining all information discussed and presented in class and posted on Blackboard. 2. Behavior in class. Students are expected to be professional in class, including paying attention to class discussion, refraining from doing other work in class, surfing the internet, passing notes, texting, or engaging in side conversations. Regular breaks will be scheduled. Students should wait until the break begins to leave the classroom, unless there is an emergency. Cell phones should be turned off or placed on vibrate during class time to avoid distracting others. Leaving the classroom and hearing cell phones ringing create distractions and interfere with the learning process. (Note: If you are expecting an important call and have your phone on vibrate, please sit in a place in the room where you can leave easily in order to take the call.) Students are expected to refrain from eating during class. 3. Participation. Coming to class having studied the assigned readings and being prepared to actively contribute to class discussions is expected. Students are expected to bring material from their experience with clients to class discussions. This may include specific case examples, ethical dilemmas encountered that are relevant to the course material or sharing knowledge obtained in the field placement. Small group exercises will occur in class. Students are expected to actively participate in any small group to which they are assigned. If the 5 atmosphere in the classroom inhibits free discussion of information, please address the issue in class. If this is not possible, please contact the instructor. 4. SDSU Faculty Senate Disability Policy: If you are a student with a disability and believe you will need accommodations for this class, it is your responsibility to contact Student Disability Services at (619) 594-6473. To avoid any delay in the receipt of your accommodations, you should contact Student Disability Services as soon as possible. Please note that accommodations are not retroactive, and that accommodations based upon disability cannot be provided until you have presented your instructor with an accommodation letter from Student Disability Services. Your cooperation is appreciated. 5. Accommodation for Religious Observances: Students will be allowed to complete examinations or other requirements in advance of a religious observance. However, it is the student’s responsibility to contact the professor in advance so that he or she can make the necessary arrangements. 6. Academic Misconduct: Academic misconduct is an act in which a student seeks to claim credit for the work or efforts of another without authorization or citation, uses unauthorized materials or fabricated data in any academic exercise, forges or falsifies academic documents or records, intentionally impedes or damages the academic work of others, engages in conduct aimed at making false representation of a student's academic performance, or assists other students in any of these acts. Academic misconduct, including plagiarism, is a serious offense in academia and will be treated according to the university policy, as written in the SDSU catalog/Graduate Bulletin. Any Academic misconduct, including plagiarism infractions, will be reported to the SDSU Office of Student Rights and Responsibilities as is mandated by the CSU Chancellor. If you are unsure as to what is plagiarism: Students can take the 30-minute pre- and post- online quiz: SDSU Plagiarism: The crime of intellectual property by SDSU librarian Pamela Jackson, found at: http://library.sdsu.edu/guides/tutorial.php?id=28. For more information visit the Office of Student Rights and Responsibility: http://studentaffairs.sdsu.edu/srr/academics1.html. 7. Policies on assignments. a. Late Assignments: The instructor expects that students will turn in all assignments by the due dates specified in the Course Outline at the beginning of class, any assignment turned in after the class starts will be considered late and marked down accordingly. No electronic assignments will be accepted. Students should contact the instructor immediately if unforeseen circumstances prevent completion of work by the due date. If the emergency is verifiable, and the instructor agrees that it justifiably prevented the student from completing the assignment, the student may negotiate an extended time frame for completing the work. Late papers will not be accepted if the student has failed to 6 contact the instructor prior to the due date. If the paper is late for any reason other than a verifiable emergency, but has been discussed with the instructor prior to the due date, the grade for the student will be reduced by 5 points each day the assignment is late including weekend days. If the student still fails to turn in the assignment by the extended due date. The instructor may choose not to accept a paper and the student would then receive a zero for the assignment. b. Incomplete grades: On rare occasions (e.g., severe illness, family emergency), an “incomplete” grade may be granted, provided the student meets the criteria established by University policies. Please see your graduate bulletin to review the criteria. c. Return of all assignments: If students would like exam #2 returned to them, they can pick it up from the instructor during office hours or provide a self-addressed stamped envelope so that the instructor can mail the assignment to them. The instructor will keep the last exam until the first week of the next semester, if the student does not claim the exam by then, the instructor will shred the exam. d. Grades: The instructor will post student grades for each assignment on Blackboard. The grades for the assignments will be weighted towards the final grade according to the percentages listed above under “Grading. 8. Communication from/with the instructor. a. Blackboard. The instructor will use Blackboard to send emails to students notifying them of documents posted on Blackboard and/or updates to course assignments. Students are responsible for ensuring that their current email is listed on the Blackboard system. The Blackboard system does not handle hotmail accounts well, so students who have a hotmail account should request a rohan account from SDSU and use it as their University email. Students should check Blackboard on the morning of the class to download any posted documents. Students requiring assistance on Blackboard are encouraged to contact the Blackboard Help Desk at http://its.sdsu.edu/bbsupport/. i. Lecture notes. Each week the instructor may post power point slides. Usually the slides are posted the evening before or morning of the class. In some cases, the slides may be provided after the topic is discussed in class. The PowerPoint slide handouts are a resource and can be helpful to students in preparing for the exam or assignments. Not all power point slides will be covered in class and not all text book material is included in the power point slides. b. Office Hours: The instructor will maintain office hours as listed on the heading of this syllabus, and will be available at other times by appointment. Students are encouraged to use the office hours to discuss questions related to the assigned readings or required assignments. The instructor also welcomes questions from students via email or phone. 7 9. Grading Policies Grades will be administered in accordance with the policies set forth in the Graduate Bulletin. The following grading scale will be utilized, please note there is absolutely no rounding up or down. A AB+ B BC+ = = = = = = 100-95 94.99-90 89.99-87 86.99-83 82.99-80 79.99-77 C = CD+ D DF 76.99-73 = 72.99-70 = 69.99-67 = 66.99-63 = 62.99-60 = 59.99 or less The instructor will determine grades in accordance with the following guidelines: 1. Grades of A or A- are reserved for student work that not only demonstrates an excellent mastery of content, but also shows that the student has (a) undertaken complex tasks, (b) applied critical thinking skills to the assignment, and/or (c) demonstrated creativity in her or his approach to the assignment. The degree to which the student demonstrates these skills determines whether he/she receives an A or an A-. 2. A grade of B+ is given to work that is judged to be very good. This grade denotes that a student has demonstrated a more-than competent understanding of the material being tested in the assignment. 3. A grade of B is given to student work that meets the requirements of the assignment. It denotes that the student has done adequate work on the assignment and meets the expectations of the course. 4. A grade of B- denotes that a student’s performance was less than adequate on an assignment, reflecting only moderate grasp of content and/or expectations. 5. A grade of C reflects a minimal grasp of the assignments, poor organization of ideas and/or several significant areas requiring improvement. 6. Grades between C- and F denote a failure to meet minimum standards, reflecting serious deficiencies in a student’s performance on the assignment. The final grade will be based on the student’s performance on the required assignments: EXAM #1 Case Study Paper February 20, 2017 20% March 20, 2017 35 % 8 Psycho-education, cultural research and Evidence Based Practice Intervention APRIL 10 & 17, 2017 20% MAY 1, 2017 20% JAN 18 – MAY 4, 2017 5% EXAM #2 Class Participation, Peer Feedback Forms, Reflections, Class Survey, Guest Speakers Feedback Forms. There are no make ups as you will need to be in class when all forms are due to receive full credit. Reflection Large Bluebook is due April 24, 2017 Course Outline: Week Date Week 1 1/23/17 Lecture and Discussion Topics Overview of Course Introductions Review of readings Review of assignments Initial group discussions Questions and answers Diversity, values and ethics What you need to know about using the DSM -5 History of DSM’s Structure of DSM 5 Arguments for and against using the DSM 5, Insurance Implementation Changes from DSM IV TR to DSM ~ 5 V & Z Codes Readings and/or Assignments Articles found on Blackboard: Lacasse, Jeffrey, After DSM -5: A Critical Mental Health Research Agenda for the 21st Century, 2014 American Psychiatric Association, DSM-5’s Integrated Approach to Diagnosis and Classification Kraemer, Helena, An Idea worth Researching: SDM Diagnosis of Mental Disorders as a Living Document Hanson: Introduction & Part l Morison: Part l & Chapter 19 DSM -5 Section 1, pp. 5-25 Other conditions, P. 715-727 Other Conditions that may be a focus on clinical treatment p.715-727 9 Week 2 1/30/17 Competency Based Assessments Bio-Psycho-Social Assessment: Looking at how attachment styles impact biology and self regulation Looking at the impact of culture on assessments Integrating Biology into Assessments Blackboard: Gray & Zide: Chapter 1: Introduction to Competency Assessment Model (available on Blackboard) Douglas Davies: Chapter 1: Attachment as a Context of Development, pp. 7-21 Hill, Jonathan, Fonagy, Peter, Safler, Ellen, Sargent, John (2014): The Etiology of Attachment in Families Morrison: Part ll Practice Assessment Skills Hanson: Part 2 Blackboard Maddux and Winstead: Cultural Dimensions Psychopathology, chapter 4 of Blackboard: Maddux and Winstead: Mini-tutorial on Brain Terminology Week 3 2/6/17 Neuroscience a critical piece of the Competency Based Assessment (CBA)– Polyvagal theory applied to assessment and diagnosis Hanson: Part IIl Levine, Peter: (27 min video) Natures Lessons in Healing Trauma https://www.youtube.com/watch?v= nmJDkzDMllc What Resets our Nervous System Practice Psycho-education Nine Steps to Reset our Nervous System Skills – Role Plays Blackboard: John Chitty (48 min video) Located on BB under week 3 Blackboard: Dr. Steven Porges: Somatic Perspective Somatic Psychotherapy Today Anniversary Interview 10 Blackboard: Harvard Center on Child Development: Children’s Emotional Development is Built into the architecture of their Brain Blackboard: Maddux and Winstead: Chapter 3: A neurobiological Perspective Week 4 2/13/17 Trauma and Stress - Related Disorders Hanson: Part lV Sleep - Wake Disorders DSM – 5 Trauma and Stress-Related Disorders Sleep Wake Disorders Blackboard: Guerda, Wheatley, Cuillaume: Does one trauma fit all? Porges, Steven: Polyvagal Theory in Treating Trauma PRACTICE SKILLS: BRING YOUR DSM Week 5 2/20/17 Anxiety Disorders and Obsessive Compulsive Related Disorders Morrison: Chapter 12 DSM 5: Anxiety Disorders Obsessive Compulsive and Related Disorders EXAM #1 – Bring Small Blue Book 11 Week 6 2/27/17 Depressive Disorders Bipolar and Related Disorders Morrison: Chapter 11 DSM 5: Depressive - Disorders Bipolar and Related Disorders PEER FEEDBACK FORMS DUE NAMI Presentation: In Our Own Voice- Week 7 3/6/17 Disorders Usually Associated with an onset in Childhood: Neurodevelopmental Disorders Disruptive Impulse –Control and Conduct Disorders Hanson: Part IV DSM 5: Neurodevelopmental Disorders DSM 5: Disruptive, Impulse Control and Conduct Disorders Blackboard: What are Executive Functions Eight Keys to Executive Functions PRACTICE SKILLS: BRING YOUR DSM Week 8 3/13/17 Neurocognitive Disorders Eating Disorders – Usually associated with onset in Adolescents Morrison: Chapter 14 DSM 5: Neurocognitive Disorders Feeding & Eating Disorders Guest Lecturer: Anne Clarkin, LCSW, UCSD Department of Psychiatry, Eating Disorder Research Guest Lecturer: Harry Eisner, Ph.D., Coordinator, Psychology Services, San Diego Regional Center PRACTICE SKILLS: BRING YOUR DSM TWO PEER FEEDBACK FORMS DUE Week 9 3/20/17 Morrison: 12 Disorders commonly associated with an onset in Adolescence: Substance-Related and Addictive Disorders Chapter 15 DSM 5: Substance Related and Addictive Disorders Guest Lecturer: Hai Duong (Hais) Lindeman, LMFT, UCSD COD Integrated Treatment Program CASE PAPER DUE PEER FEEDBACK FORMS DUE Week 10 3/27/17 SPRING BREAK Week 11 4/3/17 Schizophrenia Spectrum HAVE FUN!! Morrison: Chapter 13 DSM 5: Schizophrenia Spectrum and Other Psychotic Disorders PRACTICE SKILLS: BRING YOUR DSM Take CSP 618 Survey Week 12 4/10/17 Personality Disorders Paranoid Schizoid Schizotypal Histrionic Antisocial Borderline Avoidant Dependent Obsessive-Compulsive Narcissistic Morrison: Chapter 16 DSM 5: Personality Disorders Recommended Readings (found in library): Kaehler and Freyd (2009). Borderline personality characteristics: A betrayal trauma approach. Gurley (2009). A history of changes to the criminal personality in the DSM. Review CSP 618 Survey Groups # 1, & 2 Bring 2 Peer Feedback forms 13 Week 13 Week 14 4/17/17 4/24/17 Psycho-education, cultural research, Evidence Based Treatment Planning Review: Practice Exam and Diagnostic Skills Class Discussion: Ineptitude Jerk Groups # 3, 4, 5 & 6 Bring 4 Peer Feedback forms BRING YOUR DSM Reflection Large Blue Book due Blackboard: 2014, July 4th, The WEEK, Ineptitude Jerk Celebration & Closing Exercises Week 15 5/1/17 EXAM #2 –Bring Small Blue Book Celebrate! Bibliography Books Adler, G. (1994). Borderline Psychopathology and I’s Treatment. New Jersey: Aronson, Inc. American Psychiatric Association. (2013). DSM-5, Washington, DC: Author. Davis, Douglas (2011), Child Development a Practitioners Guide, Chapter 1, Attachment as a Context for Development, p.7-21, Guildford Press Gray, S.W., & Zide, M.R. (2012). Psychopathology: A Competency Based Assessment Model for Social Workers (2nd ed). Belmont, CA: Thomson/Brooks/Cole. Hanson, Rick, (2009). Buddha’s Brain, New Harbinger Publications Kernberg, O. (1985). Borderline conditions and Pathological Narcissism. London: Aronson, Inc. LaBruzza.A.L. (1994). Using DSM–IV: A Clinician’s Guide to Psychiatric Diagnosis. New Jersey: Aronson, Inc. Maddux, James & Winstead, Barbara (2012). Psychopathology Foundations for Contemporary Understanding, Taylor and Francis Group Meyer, R.G. (2012). Case Studies in Abnormal Behavior (8th ed). Boston: Pearson. Morrison, James (2013) Oltmanns, T.F., Martin, M.T., Neale, J.M., & Davison, G.C. (2007). Case Studies in Abnormal Psychology (7th ed). Danvers, MA: John Wiley & Sons, Inc.) 14 O’Hare, T. (2009). Essential Skills of Social work Practice: Assessment, Intervention, and Evaluation. Chicago: Lyceum Books. Paris, J. (1998). Working with Traits: Psychotherapy of Personality Disorders. London: Aronson, Inc. Journal Articles Felitti, V. (2002). The Relationship between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente Journal. (6) 1 -8. Gurley, J.(2009). A history of changes to the criminal personality in the DSM. History of Psychology. 12(4) 285-304. Heflinger, C. & Humphreys, K. (2008). Identification and treatment of children with oppositional defiant disorder: A case study of one state's public service system. Psychological Services. 5(2) pp. 139-152. Hill, Jonathan, Fonagy, Peter, Safler, Ellen, Sargent, John, (2014), The Etiology of Attachment in the Family), Family Process, Pg. 205-221. Hyde, J. S., Mezulis, A.M & Abramson, L.Y. (2008). The ABCs of Depression: Integrating Affective, Biological, and Cognitive Models to Explain the Emergence of the Gender Difference in Depression. Psychological Review (115) 2 291–313. Johnson. S.L. et al (2008). Life Events as Predictors of Mania and Depression in Bipolar I Disorder. Journal of Abnormal Psychology, (117) 2 268–277. Kaehler, L. & Freyd, J. (2009). Borderline Personality Characteristics: A Betrayal Trauma Approach. Psychological Trauma: Theory, Research, Practice and Policy, (1) 4 261-268. Kaplow, J & Widsom, C.S. (2007). Age of Onset of Child Maltreatment Predicts Mental health Outcomes. Journal of Abnormal Psychology (116) 1 176-187. Lacasse, Jeffrey, (2014), After DSM -5: A Critical Mental Health Research Agenda for the 21st Century , Research on Social Work Practice, Vol 24(1) 5-10 McQuaide, S. (1999). A social worker’s use of the Diagnostic and Statistical Manual. Families in Society, 80(4), 410-416. Manber, R. et al . (2008). Faster Remission of Chronic Depression with Combined Psychotherapy and Medication than With Each Therapy Alone. Journal of Consulting and Clinical Psychology. (76) 3 459–467. 15 Padgett, D. (2008). Social relationships among persons who have experienced serious mental illness, substance abuse, and homelessness: Implications for recovery. American Journal of Orthopsychiatry. 78(3), 333-339. Wilkinson-Ryan, T. & Weston, D. (2000). Identity Disturbance in Borderline Personality Disturbance: An empirical Investigation. American Journal of Psychiatry. (157.4 528541. 16