The world of the Counselor An introduction to the counseling profession 5e chapter 17

Clinical Mental Health Counseling

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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How CACREP defines Clinical Mental Health Counseling
 Content knowledge in 8 areas common to all CACREP programs (e.g.,
school, clinical mental health, college counseling, etc.)
 Additional coursework in such things as psychopahtology,
psychopharmacology, treatment planning, addictions, marriage and
family, and more.
 2009 CACREP standards did away with the 48 hour community
counseling program
 Today, CACREP requires 54 credits for Clinical Mental Health
Counseling
 After July 2013, CACREP will require 60 credits for Clinical Mental
Health Counseling

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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In most states, if you don’t go through a CACREPaccredited program you can still get licensed
Most states require that you have 60 credits in Clinical
Mental Health Counseling (or related counseling specialty
—e.g., agency counseling) to be eligible to become a
Licensed Professional Counselor.
There still isn’t easy transferability from one state to
another as states often have similar, yet different
requirements to be an LPC
See Box 17.1, p. 581: What a Long Strange Road Its Been

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Turn of 20th century
 Emotional problems seen as psychological in nature
 Freud—1st comprehensive theory
 Sanitariums became more humane
 Vocational guidance and counseling
1930s

 Federal money for mental health treatment and research
 Increasing humane mindset toward mental illness
1940s
 New approach to counseling that encapsulated
psychoanalysis, counseling, existentialism, and American
take-charge philosophy.

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1940s (Cont’d)
 New approach was optimistic and short-term compared to
psychoanalysis
 Around WWII, assessment techniques increasingly used
 Recovery rates of emotional illness from the war were high
 NIMH created

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1950s
 Mental Health Study Act of 1955
 Expansion and acceptance of mental health services
 Widespread use of psychotropics

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1960s

 Upheaval in American Society
 More social programs: Johnson’s “Great Society”
 1963: Community Mental Health Centers Act

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1960s and 1970s
 Expansion of mental health centers and funded substance
abuse treatment
 1975: Donaldson vs. O’Connor
 Rehabilitation Act of 1973
 President Carter (and Rosalind): Focused on mental health
 Establishment of AMHCA

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1980s to 1990s
 Reagan’s Block Grants limited some services

 Expansion and diversification of field
 More diversification of settings

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Most Recently
 36% of counseling graduates are in clinical mental health
 Today we find graduates in wide a large variety of settings
 Gradual acceptance of diagnosis and psychopharmacology
(see Table 17.1, p. 584)

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Most Recently (cont’d)
 More credentials (e.g., 50 states have licensing)
 Licensing is most important step toward counselors
obtaining third-party reimbursement
 Increased inclusion of counselors receiving third-party
reimbursement
 Patient Protection and Affordable Care Act (2010) expands
mental health benefits of state insurance exchanges
 More acceptance of use of diagnosis and psychotropic
drugs

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MOST COMMON ROLES

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Case manager
Appraiser of client needs
Counselor
Consultant
Crisis responder
Supervisor/supervisee
Supervisor/supervisee
Accountability evaluator
Other?

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

OTHER LESS COMMON ROLES

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Outreach worker
Broker/Networker
Advocate
Evaluator
Teacher/educator
Community planner
Administrator
Clinical assistant

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Other, Less Common
Roles
 Outreach worker
 Broker/Networker
 Advocate
 Evaluator
 Teacher/educator

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Other Less Common Roles
 Community planner
 Administrator
 Clinical assistant

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Another classification of roles and function:
 Primary, Secondary, and Tertiary Prevention
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Primary: Prevention and wellness
Secondary: Control of nonsevere emotional problems
Tertiary: Control of serious mental health problems
See Figure 17.1, p. 587

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Due to the number of different types of settings, it is difficult to talk
about a theoretical focus.
 However, Hershenson et al., (2003) offer 7 principles that govern the
ways counselors deliver services at all agencies:
1. Respect the client.
2. Provide a facilitative environment that fosters client progress.
3. Help clients actively define goals in order to promote growth and
development.
4. Empower clients and help them understand that counseling is an
educational process involving client learning.
5. Focus on client strengths, not weaknesses.
6. Focus on both the person and the context (environment).
7. Use techniques shown to be valid through prior research.
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Career and Employment Agencies
 Associations: AMHCA; NCDA; NECA

Community Mental Health Centers
 Association AMHCA
Correctional Facilities
 Associations: AMHCA; IAAOC
Family Service Agencies
 Associations: AMHCA; IAMFC; AAMFT
Gerontological Settings
 Associations: AMHCA; AADA
 See Box 17.2, p. 591

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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HMOs, PPOs, and EAPs
 Association: AMHCA

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Military and Government
 Association: AMHCA; ACEG
 See Box 17.3, p. 592

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Pastoral, Religious, and Spiritual Agencies
 Association: AMHCA, ASERVIC, AAPC

 See Box 17.4, p. 592

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Private Practice Agencies
 Association: AMHCA
 See Box 17.5, p. 595

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Rehabilitation Agencies

 Associations: ARCA; NRCA

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Residential Treatment Centers

 Associations: AMHCA; ARCA, NRCA
 See Box 17.6, p. 597

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Substance Abuse Settings

 Associations: AMHCA, IAAOC

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Youth Service Agencies

 Associations: AMHCA; ASCA

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Other Settings?

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Clinical mental health counselors need to be aware of following:
1. Clients from nondominant groups are underrepresented at mental
health centers
2.Clients from nondominant groups are frequently misunderstood,
misdiagnosed, find therapy not helpful, attend therapy at lower
rates, and are more likely to terminate therapy
3. Clients from cultural backgrounds different from their counselor’s
may experience counseling more negatively than others
4.Most counseling theories are Western-based and might be
dissonant with some minority cultures’ values and attitudes
5.Some clinical mental health counselors may not have the

sensitivity or training necessary to work with minority clients
6.Some mental health counselors have an ethnocentric worldview

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Assessment of Clients at Agencies
 Be careful about bias in tests
 Remember, that to some degree, diagnoses are culturally
predisposed
 Consider “culture-bound” diagnoses

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Limited Number of Counselors from Diverse Cultures
 Agencies need to actively hire more minority counselors
 Counselor Ed programs need to actively recruit more
students of color

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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 Ethical Issues
 Ethical Complaints and Ethical Concerns

 Ethical complaints made against LPCs (Neukrug, et al. (2001):
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24%: inappropriate dual relationship
17%: incompetence in the facilitation of a counseling relationship
8%: practicing without a license or other misrepresentation
7%: having a sexual relationship with a client
5%: breach of confidentiality
4%: inappropriate fee assessment
1%: failure to inform clients about goals, techniques, rules, and
limitations of the counseling relationship
• 1%: failure to report abuse
• 33%: Other
© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Ethical Issues

Perceptions of what is and is not ethical (see Table 3.1, p. 68)
 Counselors have little agreement about some situations

 Professional Issues
 AMHCA
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▪ Addresses needs of wide spectrum of agency/mental counselors
▪ Purpose: To enhance the profession of mental health counseling
through licensing, advocacy, education and professional
development
▪ Provides a wide range of member benefits
▪ Quasi independent from ACA

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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 Professional Issues
 Credentialing
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Clinical Mental Health Counselor Certification (CMHCC)
Masters Addictions Counselor (MAC)
Nationally Certified Counselor (NCC)
Licensed Professional Counselor (LPC)

 Outlook and Salary
▪ Outlook: Strong

▪ Salary: $25,000 to $40,000 entry level
▪ Salary: $50,000 or more with advancement
▪ Salary: $100,000 or more in private practice and networked

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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 Legal Issues
 HIPAA

▪ Provide information to patients about their privacy rights and
how that information can be used.
▪ Adopt clear privacy procedures for their practices.
▪ Train employees so that they understand the privacy
procedures.
▪ Designate an individual to be responsible for seeing that
privacy procedures are adopted and followed.
▪ Secure patient records.

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Legal Issues
 Confidentiality of Records Assured by:

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HIPAA
FERPA (Buckley Amendment)
Freedom of Information Act
Client’s to their records

▪ They have rights to view their records (except process
notes)
▪ Parents usually have rights to view their children’s
records

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Legal Issues
 Confidentiality and Privileged Communication

▪ Licensed practitioners have privileged communication
▪ The privilege is held by the client

 Confinement Against One’s Will
▪ As result of Donaldson v. O’Connor, one can no longer be held

against his or her will unless he or she is at danger of harming
self or other
▪ Individuals can generally be held for short amount of time,
pending court hearing

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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Growing, Changing, Accepting
 The ever-increasing acceptance of diagnostic tools such as
DSM-IV-TR
 The dramatic shifts in the health care delivery system
 The increase in the kinds of counseling services offered
 The ever-increasing knowledge of multicultural issues and
their effects on client treatment
 The development of new ways of treating individuals with
various emotional problems

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

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