In this article, we propose that emotional reactivity can influence dialogue around the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the wider issues included in the debate. We explore this emotional process and the impact that it has on our clinical practice, our clients' experiences, our experience of ourselves as clinicians and the ways we work with other professionals. We begin by presenting clinical scenarios, then briefly summarise key ideas from the DSM-5 debate, and draw on Bowen Family Systems Theory to explore a number of ways that emotional reactivity to these ideas can manifest itself in multidisciplinary and collegial relationships. We conclude that it is helpful to increase awareness of our own emotional processes to best avoid becoming reactive to, or dismissive of, alternative paradigms or knowledge bases that may be of use to our clients. We describe a number of principles and ideas that we have found useful in this context and identify ongoing dilemmas in our practice.1 The advent of DSM-5 brings back into focus dilemmas within therapy and mental health around the complexity of different paradigms being used in the best interests of the client and family. 2 The debate is substantial because of far-reaching implications for the whole counselling and mental health field. 3 At the coalface, these dilemmas are not purely theoretical and frequently raise strong feelings around intensely held personal and professional values for the clinician. 4 Emotional reactivity can affect how we see our clients and the options available to them, and the way we collaborate with colleagues in providing care. 5 Applying a theoretical understanding of emotional processes can be useful for reflecting on personal and professional functioning and can provide options for working within a multi-paradigm workplace.The imminent release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has evoked an increased focus on diagnosis, the medical model and the struggle to describe complex human situations adequately. As members of multidisciplinary teams in a publicly funded child and adolescent mental health setting whose overarching frame is systemic 1 , we have watched this discussion with interest. Over time, we have become increasingly aware of the role of emotional responses in this process, both in terms of the impact on the broader debate, in our daily workplace, and within ourselves. This article seeks to explore this issue as it relates to our day-to-day work: with clients and their families/carers; alongside other clinicians in our teams; with the referrers of our clients and other services to which we refer. We have approached this

There is a long history of literature concerning integrative practice and how a systemic practice can fit with other models of therapy Much of this literature has focused on establishing a space for systemic therapy within the dominant medical paradigm, and exploring how the medical model can be enhanced by systemic ideas. The outcome has been better practice, especially in child and adolescent mental health. Interestingly, however, there has been less discussion of the converse: the family therapy literature has rarely considered whether or not systemic practice itself can be enhanced by ideas from the dominant medical model. This article proposes that a biopsychosocial formulation can enhance systemic practice by: (I) holding clinicians accountable for their thinking; (2) facilitating a rigour and attention to detail that may prove useful when therapy falters; (3) opening up other possibilities for intervention; and (4) providing a way to engage with the dominant medical paradigm and support clients in negotiating their way through this system. Potential problems nevertheless arise when integrating a biopsychosocial formulation into a systemic framework. This article identifies these problems and presents ideas for how they can be managed in practice.

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