Clinical mental health counseling is a healthcare profession addressing issues such as substance abuse, addiction, relational problems, stress management, as well as more serious conditions such as suicidal ideation and acute behavioral disorders. Practitioners may also assist with occupational growth in neurodivergent populations and behavioral and educational development.Clinical Mental Health Counseling: Elements of Effective Practice (Edited by Young & Cashwell, 2016). Clinical mental health (CMH) counselors include psychologists, psychiatrists, mental health technicians, marriage counselors, social workers, and family therapists.
Historical perspectives
Origins of counseling In the early 1900s, counseling had not yet developed into treating mental health issues and was more focused on education. Frank Parsons, developed a plan to educate counselors and began the Vocational Guidance Movement. He was concerned with the problems of youth as youth unemployment became a major concern for adolescents as urbanization occurred, and sustainable work and family income generated on family farms was not as prevalent. At this time, counselors were considered vocational, initiating the approach that began to form the more contemporary counseling process. Around the same time, Clifford Beers, a former patient of mental health hospitals, wrote a book exposing the terrible conditions of mental health institutions and advocated for reform. Beers later founded the National Committee for Mental Hygiene, which became the National Mental Health Association. Jessie B. Davis was the first individual to make guidance a regular part of the school curriculum. He was a superintendent or administrator and advocated for what became school guidance and counseling.
During the Great Depression, counseling methods and strategies for employment grew as it was greatly needed at the time. In 1932, Brewer wrote a book entitled Education as Guidance, which promoted the broadening of counseling beyond just occupation. He suggested that every teacher share the implementation of counseling and that guidance needed to be in every school curriculum.Locke, D. C., Myers, J. E., & Herr, E. L. (2001). The handbook of counseling. Thousand Oaks, CA: Sage Publications In the 1940s, Carl Rogers began the development of counseling and psychotherapy. He believed that the client knows best and that only they could explain what their needs are and what direction to go in counseling based on what problems were crucial and needed attention. Rogers clearly indicated that he was not doing psychology and the courses he taught were based in the Department of Education.
World War II brought to the forefront the importance of testing and placement as there was a strong need for the selection and training of specialists for the military. Counselors and Psychologists had the necessary skills to fill this much needed role. The Veterans Administration provided professional counseling services to soldiers after their discharge and in 1945, the VA granted stipends and internships for students in counseling and psychology, boosting the support and training available to counselors. This time marked the beginning of government spending on counselor preparation as we know it today. Clinical psychologists were trained to treat and diagnose individuals with chronic disorders, and counseling psychologists were trained to deal with issues presented by people with more severe mental health issues. This led to a new division or category of psychologists and the Division of Counseling and Guidance of the American Psychological Association changed its title to the Division of Counseling Psychology.
Professionalization of mental health counseling In the 1950s, flaws in the existing mental health system were being exposed and clinically effective pharmacological treatments were also being developed that could be provided in outpatient settings. This led to a need for community-based clinics, but access to these services was limited. The Community Mental Health Act of 1963 was very important in the development of the counseling profession. After the government analyzed the problems with mental illness and effective treatments, President John F. Kennedy believed that high-quality treatment centers located in the patient's community could lead to the phasing out of state mental hospitals and drastically improve the mental health system in the United States. The national network of community mental health centers created a demand for counselors and the profession began to expand and increase the number of counselors.
As the counseling profession grew, there became a need to regulate the quality of services being provided by professionals via state licensure. In 1974, a special committee was appointed by the American Personnel and Guidance Association that focused on counselor licensure. This began the steps towards the first counselor licensure law in Virginia in 1976. By the 1980s, mental health counseling had clearly established itself as a profession with a distinct set of regulations and methods for providing services. According to Gerig, a distinct professional is characterized by "role statements, codes of ethics, accreditation guidelines, competency standards, licensure, certification, and other standards of excellence." The counseling profession as we know it today has established all of these facets of a distinct profession and is being recognized more and more as a valuable and much-needed helping profession in our society.
Education, licensure, and certification
Licensure Counselor licensure is established by state law and is required of all professional counselors in the United States and U.S. territories. Receiving a license in counseling indicates that one has met the minimum standards to practice counseling in that state. State laws vary in the requirements that must be met to obtain a license. Candidates must have at least received a master's degree, have had post-master's supervised practice, and have passed a national exam.
The number of credit hours to be completed varies from one state to another, as does the number of supervised hours that must be completed, and the counselor titles used. Moving from one state to another may require taking additional courses in order to qualify for the license in the other state.
Common education requirements In order to become licensed as a Licensed Professional Counselor (LPC) or Licensed Professional Counselor Associate (LPCS), students need to study for many hours in different fields of mental health, general psychology, and others. These usually include: Internship Experience for Certification Orientation to the Counseling Profession Research Career, Vocational, and Lifestyle Development Human growth and Development Social and Cultural Foundations Counseling Theories and Techniques Appraisal from peers Group Work Practicum and Internship
Examination requirements The LPC applicant must obtain a passing score on a national exam, such as the National Counselor Exam (NCE), the National Clinical Mental Health Counseling Exam (NCMHCE), or the Certified Rehabilitation Counselor Exam (CRC). The first two exams are offered by the National Board for Certified Counselors (NBCC) and the third exam is offered by the Commission on Rehabilitation Counselor Certification (CRCC). In addition to the national exam, applicants must complete a no-fail Jurisprudence Exam, which covers information on laws and ethical codes.North Carolina Board of Licensed Professional Counselors. (2014). Licensed professional counselor. Retrieved from http://www.ncblpc.org/application-info/lpc
Supervision requirements Applicants must have completed over 3,000 hours of supervised counseling practice. Supervisees should receive one hour of live supervision per forty hours of practice. 2,000 or more hours must involve direct client contact.
Certification Certification is a voluntary credential that can be acquired by counselors as well. According to Remley and Herlihy, there are two national certification agencies for the counseling profession. These are the National Board for Certified Counselors (NBCC) and the Commission on Rehabilitation Counselor Certification (CRCC). The NBCC also offers specialty certifications. The information regarding the certifications provided by the NBCC is outlined below.
National Certified Counselor (NCC) According to Remley and Herlihy, this certification is granted by the National Board for Certified Counselors (NBCC) after an individual has met certain requirements. These include: Completion of a master's degree in counseling Completion of two years post-master's experience If an individual graduates from a program that is accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP), the two years of post-master's experience requirement is waived. Acquisition of a passing grade on the National Counselor Exam (NCE)
Certified Clinical Mental Health Counselor (CCMHC) According to Gerig, counselors seeking the CCMHC specialty credential must meet the following requirements: Obtain the National Certified Counselor (NCC) certification Complete 60 hours of graduate coursework including courses in: Theories of Counseling Psychotherapy Personality Abnormal Psychology and Psychopathology Human Growth and Development Professional Orientation and Ethics Research Testing Social/Cultural Foundations Complete an academic program with 9–15 hours of clinical training in a supervised practicum/internship in a mental health counseling setting Acquire a passing score on the National Clinical Mental Health Counseling Exam (NCMHCE) Submit an audiotape or videotape of a counseling session
Master Addictions Counselor According to Gerig, the Master Addictions Counselor (MAC) specialty certification is intended for counselors treating substance abuse and dependence. Counselors seeking this credential must complete the following requirements: Obtain a National Certified Counselor (NCC) certification Document at least 12 semester hours of graduate work in addictions or 500 hours of continuing education units Complete 3 years of supervised experience as an addiction counselor Obtain a passing score on the Examination for Master Addiction Counselors (EMAC)
Professional organizations Professional organizations exist to serve many different functions. They provide an assembly for professionals to gather to discuss issues and problems that exist within the profession. Organizations allow the members of a profession to address issues as a group rather than facing these issues independently. Professional organizations provide an outlet for legislative activity and leadership regarding particular issues that affect the profession at all levels. Continuing education is a critical requirement for members of a profession as it ensures that all professionals' skills and expertise are continuously updated to reflect the most current research and recommendations; professional organizations provide this continuing education to their members. These organizations also assist in keeping professionals up to date by providing scholarly journals, books, and media resources to their members. Lastly, professional organizations publish and enforce a code of ethics for their members.
The following professional organizations are the primary ones available to those within the clinical mental health counseling profession.
American Counseling Association (ACA)