This paper explores Samuel Gladding's book Counseling: A Comprehensive Profession as well as two published articles by Smith, Robinson and Fields’ on key moments in the history of clinical mental health counseling. The paper begins with Clifford Beers exposing mental health institutions in the early 1900s which sparked the mental health movement and the organization of associations within the profession. Smith and Robinson (1995) detailed the significant movements and acts that happened in the past, brought the profession to the present and the hopes for the future. Field (2017) spoke on the past 40 years in the clinical mental health profession also highlighting important moments in counseling history. Gladding’s book as well went through the decades of counseling and provided knowledge on important associations, employment in the field and key issues mental health counselors face. This paper illustrates a broad picture of the history of clinical mental health while bringing focus to important associations and legislation in the profession.
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Mini Research Paper
The history of clinical mental health counseling begins with Clifford Beers who shared his truth about what was happening in the mental institutions in the early 1900s. Beers’ book A Mind That Found Itself (1908) was used to advocate for improvements in mental health centers and provide better treatment for individuals in these facilities. Furthermore, Beers’ sparked the mental hygiene movement in the United States, as well as advocacy groups like the National Mental Health Association and the National Alliance for the Mentally Ill that still operate today. The focus of the early 1910s was on vocational guidance and school guidance counseling, therefore the National Vocational Guidance Association (NVGA) was formed. As counseling grew as a specialty so did its association; in the 1950s, it was renamed the American Personnel and Guidance Association (APGA), in 1980’s it changed to the American Association for Counseling and Development (AACD), and finally American Counseling Association (ACA) in the 1990s.
Community Mental Health Act
Mental health counseling did not see its first significant piece of legislation until 1963, called the Community Mental Health Act. The CMHA act was significant to the mental health counselor movement because it promoted local mental health initiatives and provided funding for more than 2,000 community health centers in the United States. CMHA also provided employment for local mental health counselors with a variety of specialties, “for instance, alcohol abuse counseling and addiction counseling, initially called drug abuse counseling” (Gladding, 2018). The movement also pushed for mental health education through outreach programs.
American Mental Health Counselors Association (AMHCA)
By the 1970s, mental health counselors were looking to form a professional organization for support and networking to help define the profession. In addition, Smith and Robinson (1995) stated:
By the mid-1970s, it was clear that there was a critical mass of these individuals who (a) were educationally prepared at either master's or doctoral level; (b) worked in community agencies, community mental health, or private practice settings; (c) were delivering a wide variety of services very similar to the more established mental health care provider groups (psychiatry, psychology, social work, etc.); and (d) felt they had no professional home by virtue of their uniqueness. (p. 159)
As a result, the American Mental Health Counselors Association (AMHCA) was formed in 1976, one of the largest divisions of the APGA and helped organize the mental health profession so that it could operate with roles and goals. In the 1980s, AMHCA promoted for accreditation for other related specialties like mental health counseling; including family and marriage counseling. “In keeping with the strong emphasis on competency-based programs, it was the considered opinion of AMHCA that programs preparing mental health counselors to enter certain areas of specialty in practice should also guarantee skill and provide for supervised clinical instruction for these specialty designations” (Smith et al., 1995).
Clinical mental health counseling associations like the AMHCA next major focus was on gaining licensure and clear laws within the professions. Field (2017) went on to say that:
Since its inception in 1976, the American Mental Health Counseling Association (AMHCA) has taken a strong position on the need for high counselor preparation standards in the establishment of licensure, credentialing, and reimbursement for services by third parties such as federal and private health insurance companies. (p. 1)
By the mid-1970s, the APGA was moving closer to state and national licensure for counselors. "Thomas J Sweeny (1991) chaired the first APGA Licensure Committee and he and his successors did so with much success” (Gladding, 2018 ). Therefore, Virginia became the first state to have a professional counselor licensure law in 1976. Several states followed after Virginia, some of the firsts being Arkansas and Alabama. However, Smith et al. (1995) stated, licensure laws differ from state to state. For example, “counselor licensure laws have resulted in the use of at least 16 different titles and a different definition of counseling in virtually every state” (Smith et al., 1995). Licensure laws can either be title acts or practice acts; these acts either protect the title for which the counselor holds or require the counselor to obtain a license to practice. Furthermore, the APGA was becoming a stronger organization, and associations like the Association of Counselor Education and Supervisors (ACES) were outlining the standards for masters and doctoral degrees. Mental health counseling had become a defined professional and was continuing to grow its specialties and emphasizing human growth and development.
In the 1980’s it became clear that mental health counseling would not be recognized without standards for training and certification. Therefore, “In 1981, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) was established with the mission to accredit counseling programs” (Field, 2017). CACREP polished the standards first introduced by the ACES and began to standardize counseling programs at the master and doctoral levels. Field (2017) further stated:
In 1982, the National Board for Certified Counselors (NBCC) was established to support the national credentialing of counselors. This has included the administration of examinations required for counselor licensure, most notably the National Counseling Exam (NCE) and the National Mental Health Counseling Exam (NCMHCE). (p. 2)
Finally, the National Academy of Certified Clinical Mental Health Counselors (NACCMHC) worked together with CACREP to continue to standardize the profession and certify mental health counselors, as well as, began to train supervisors for the field in the late 1980s which brought in more counselors to the field.
Employment of Clinical Mental Health Counselors
Clinical mental health counselors have transitioned away from vocational and schools to now a wide range of settings. Some of these settings include mental health centers, psychiatric hospitals, health and maintenance organizations (HMOs) and health and wellness promotion programs (HWPs). “One place where clinical mental health counselors are being hired in increasing numbers is employee assistance programs (EAPs)” (Gladding, 2018). The purpose of EAPs is to help individuals work through problems they have or may face that could cause disruptive behavior in the workplace. EAP counselors also provide short-term counseling for workers who are experiencing difficulties. However, EAPs are time-limited but refer the client to another mental health counselor if the client needs further counseling. “Another place where clinical mental health counselors may be employed is with crisis-oriented organizations, such as Red Cross, Salvation Army, or local emergency telephone and walk-in counseling centers” (Gladding, 2018 ). In crisis respondents may see a variety of physical or mental needs; therefore, counselors are a vital part in helping the client receive counseling and support. Counselors working in this field may have abnormal hours and may find this job challenging at times. Lastly, counselors can also find employment in settings like “substance abuse, hospice, child guidance clinics, wellness centers, colleges, hospitals, and private practice” (Gladding, 2018 ). The reason counselors are able to be employed in a wide range of settings is due to CACREP standards for training that provides counselors with the knowledge to help with a variety of problems.
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Future Trends and Issues
The field of clinical mental health counseling is continuously growing and improving and striving toward providing the best services for those in need. Therefore, Smith et al. (1995) described the future of CMHC as stated, “on the basis of changes in the health care marketplace, we believe that the term mental health counseling will come to mean the delivery of counseling services along the full continuum of mental health services”. The CMHC profession will continue to develop to serve the needs of the mental health community, counselors will continue to be qualified to work with a continuum of mental health services. “We anticipate that all practicing mental health counselors will have basic knowledge and skills in the diagnosis and treatment of mental disorders as a part of their core coursework” (Smith et al., 1995). Issues mental health counselors are still facing today are problems such as license portability; for example, Field (2017) stated:
If a counselor decides to re-locate and practice in another state, the new host state may not allow the re-located counselor to transfer the license from their home state to their new host state, because licensure may be in consistent between the two states. (p. 5)
Issues like license portability are something the counseling profession hopes to work towards in the future to maintain the goals to adequately serve and advocate for those in need in any state.
Field, T. A. (2017). Clinical Mental Health Counseling: A 40-Year Retrospective. Journal of Mental Health Counseling, 39(1), 1–11. doi: 10.17744/mehc.39.1.01
Gladding, S. T. (2018). Counseling: A Comprehensive Profession (8th ed.). Boston: Pearson.
Smith, H. B., & Robinson, G. P. (1995). Mental Health Counseling: Past, Present, and Future. Journal of Counseling & Development, 74(2), 158–162. doi: 10.1002/j.1556-6676.1995.tb01842.x
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