There are numerous ethical considerations inherent within the process of assigning a "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.; "DSM-IV-TR"; American Psychiatric Association, 2000) diagnosis. In this article, general ethics considerations such as informed consent and confidentiality, accuracy of diagnosis, and multiple relationships are examined as they relate to clinical mental health counselors' use of the "DSM-IV-TR". The article concludes with the authors' suggestions for ethically sensitive diagnostic practices.