Many counselors, social workers, and psychologists routinely use the DSM-IV-TR as a basis for most psychological diagnoses. This includes counselors' work with clients from diverse cultural backgrounds. Multicultural counseling theorists and practitioners are beginning to voice their concerns about finding a more appropriate alternative to the manual, a manual that is more inclusive of cultural differences while being compatible with counseling philosophy. Use of the DSM-IV-TR is a highly controversial issue in the counseling profession and yet the idea of an alternative may prove to be even more controversial. A review is included of some of the interdisciplinary social, cultural, and political issues surrounding its use as they pertain to any future alternatives. It describes some basic concerns that may be useful in understanding the nature of the controversy and in identifying any future alternative for multicultural counseling. It focuses on multicultural counseling as a human relations issue. (Contains 76 references.) (JDM)