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Professional counselors in educational and mental health settings all must deal with so-called psychopathology. At issue is how can they work with “disorder” from a positive, developmental perspective? Developmental counseling and therapy (DCT) offers an approach to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) classification systems that enables the reframing of severe client distress as a logical response to developmental history. Included are specific suggestions for positive case management and practice. Special attention is given to the interface of multicultural issues, etiology, and treatment. The authors maintain that if professional counselors take a developmental approach to a so-called disorder, the positive theoretical and psychoeducational integrity of the American Counseling Association can be maintained while working with the most difficult issues.