The revision process for the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.; American Psychiatric Association, 2000) has increased consciousness for the role of diagnosis in counseling. In this article, the authors discuss 3 trends of the proposed changes: the influence of the medical model, the attention to nosology, and lowered thresholds and their potential impact on nondominant populations. Potential implications for reflection and advocacy among counseling professionals are discussed.