The History of Clinical Mental Health Counseling

Abstract

Clinical mental health counseling is often confused with its closely related neighbors psychology, psychiatry and social work. This paper examines the profession’s growth throughout history into its own distinct identity.  The origins of philosophy on mental health from early Greek and Roman philosophers are traced.  The inhumane and humane treatments of those suffering from mental illnesses in the Middle Ages are highlighted.  The scope of counseling as a profession before and after World War I and World War II is discussed, and the political agendas that paved the way for a distinct identity as a clinical mental health counselor are highlighted.  

The History of Clinical Mental Health Counseling

The professional identity of clinical mental health counseling can sometimes be confused when viewed only in the present. Gerig (2014) wrote, “Clinical mental health and professional counseling is still the new kid setting up residence on the block where the other mental health professions have lived” (p. 2). The profession has commonalities with its historical neighbors, but there are unique identities that set the profession apart (Gerig, 2014). Relevant history best outlines the emergence of a professional identity for clinical mental health counseling. Leahey (1980), with regard to the discipline of psychology, noted:

The events of today are influenced by the historical past and will influence the historical future. To understand what we are doing and why we are doing it, we need to understand what psychologists did before us as well as the nature of historical change. To ignore the past is to cut off a source of self-understanding. (p. 14)

Mental health and illness theories are not new to the 20th century. Gerig (2014) wrote, “Useful sources of information are the study of myth, comparative religion, and the writings of early philosophers” (p. 2). References to madness and confusion of the mind were given in the Old Testament of the Christian Bible. According to Gerig (2014), “Early distinctions were made between behavioral conditions beyond human control and those related to poor judgment and faulty decision making” (p. 22).

Early Greek philosophy also gives insight into the views of mental illness and its treatment. Hippocrates (406-377 BCE) believed that aberrant behavior had natural causes and should be treated as a physical ailment (as cited in Viney & King, 2003). Plato (428-348 BCE) thought abnormal behaviors stemming from madness required a community response (Plato, n.d.).

The Middle Ages were branded by both humane and cruel treatments toward persons who exhibited aberrant behaviors. Behaviors not readily explained were attributed to supernatural causes. Gerig (2014) wrote, “Humans were thought to be the site where the ultimate battle between good and evil took place” (p. 23). Abusive “water tests” were used to identify whether or not a person collaborated with the devil. In contrast, the Colony of Gheel grew into a center of care for the mentally ill that was characterized by love and kindness (Gartland, 2000). During the 16th century, Europe developed a system of hospitals known as asylums. These institutions were built to provide shelter for people who were not able to take care of themselves. Residents were frequently kept in restraints and left to lie in their own waste, making the conditions deplorable (Whitbourne & Halgin, 2014). During the 1700s, advocates for more humane approaches to mental illness ushered in the moral treatment movement (Linhorst, 2006). The movement was initially opposed by those in the mental health profession. By the mid-19th century, the tireless work of advocates like Dr. Benjamin Rush (1745-1813) and Dorothea Dix (1802-1887) influenced psychologists to adopt the strategy (Parry, 2006). Making the argument stick for moral treatment has been described by Gerig (2014) as “an important step in the profession’s eventual success at securing a monopoly on the treatment of ‘lunacy’” (p. 176).

Early philosophy demonstrates that healthy and unhealthy forms of behavior have been distinguished by societies (Gerig, 2014). Furthermore, some behaviors were thought to be under conscious control, and some forms were not. As various mental health professions emerged, the fundamental framework for treating pathology or treating to enhance the human function remained intact (Gerig, 2014). According to Fancher (1995), “Professional care for mental health has evolved from giving ‘moral treatment’ to the clearly deranged, to claiming to offer, in the name of scientific advance, access to live reasonably free from emotional distress” (p. 53).

In 1879, Wilhelm Wundt established the first psychological laboratory at the University of Leipzig in Germany. This is thought to be the origin of psychology because he was a philosopher and physiologist who viewed psychology as the study of immediate experience (Resnick, 1997). When he set out to create a science of the mind and behavior, the discipline of psychology emerged as an academic field.

The American Psychological Association (APA) was formed in 1892 by a group of philosophers, educators, and physicians (Resnick, 1997). The organization decided not to incorporate a philosophical psychology division in 1898; and psychology moved toward psychophysics, animal behavior, and human assessment and away from philosophy (Sokal, 1992).

In 1908, William Healy, a Freudian psychoanalyst, established the Juvenile Psychopathic Institute (Gerig, 2014). The Chicago-based clinic was historically significant in the discipline of psychology. First, Laughlin and Worley (1991) noted that it was the first psychiatric clinic within the community. Second, the clinic was the first recorded institution to integrate “psychological skills and training for the treatment of social problems” (Gerig, 2014, p. 26). Until this time, applied psychology had been limited to mental testing. Third, Gerig (2014) identified that “the clinic used a multidisciplinary approach to treatment” (p. 26). The psychiatrists conducted therapy sessions, the psychologists facilitated testing and assessments, and a social worker focused on dealing with any problems the patients had at home (Rogers, 1961).

Around this same time, problems of youth unemployment became a major concern for adolescents. Urbanization had occurred, and sustainable work on family farms was not as available (Whiteley, 1984). Frank Parsons, known as the father of guidance, recognized the impact of this transition, and in 1908, he developed the Boston Vocation Bureau (Gerig, 2014). The goal of the bureau was to identify the aptitudes and the interests of a young person and match them with occupational choices (Smith & Weikel, 2011).

Gerig (2014) identified Parsons as a key contributor to the development of professional counseling, writing:

First, his approach was clearly directed to relatively normal youth who were facing a developmental transition. Second, the method of vocational counseling had prevention as a foundational goal. Third, Parson’s questionnaire could be self-administered and included input from family, friends, and teachers. (p. 26)

His work encompassed numerous theoretical emphases and processes of clinical mental health counseling in its most elementary form.

 In 1908, Clifford Beers, a former mental hospital patient, wrote the book, A Mind That Found Itself. In the book, Beers exposed the horrible conditions of mental health institutions and advocated for reform. The book’s popularity shed light on the struggles of the mentally ill in the United States. He used the momentum to form The National Committee for Mental Hygiene in 1909. It became the forerunner for the National Mental Health Association (Smith & Weikel, 2011).

The Great Depression created a need for counseling methods and strategies to aid in employment. In 1932, John Brewer wrote Education as Guidance. The book helped broaden counseling’s scope beyond occupation. He suggested that teachers share in the implementation of counseling and that guidance needed to be a part of every school curriculum(Gladding, 2018).

Carl Rogers’ book, Counseling and Psychotherapy, was published in 1942. The book emphasized a nondirective approach to counseling (Gladding, 2018). Rogers (1961) summarized his essential hypothesis: “If I can provide a certain type of relationship, the other person will discover within himself the capacity to use that relationship for growth, and change and personal development will occur” (p. 33). His approach laid the foundation for professional counseling. Out of nondirective counseling grew client-centered and person-centered therapy.

During World War II, psychologists, counselors, and social workers came together to work with psychiatrists on the front lines. Few of them had doctoral degrees and many had minimal clinical experience (Gerig, 2014). In addition, the military and industry needed help with the selection and training of specialists. Soldiers were entitled to professional counseling services upon being discharged. The Veterans Administration obtained additional funding to support the training of such mental health professionals. Simultaneously, the APA’s Committee on Training in Clinical Psychology (1947) developed a training philosophy and model of clinical training. Attendees at a conference in Boulder, CO endorsed this model, which ultimately led to the requirement of a PhD for clinical psychologists. University programs quickly responded and began offering doctoral degrees in both counseling and clinical psychology (Cummings, 1990). Counseling psychologists were trained to deal with issues presented by people with mental health. Clinical psychologists were trained to treat and diagnose individuals with chronic disorders. This led to a new designation for psychologists and marked the introduction of government spending on counselor preparation, as we know it today. The Division of Counseling and Guidance of the APA changed their title to the Division of Counseling Psychology.

Flaws in the mental health system began to surface in the 1950s. Effective pharmacological treatments were developing that could be provided in outpatient options for patients. This led to a need for community-based clinics, but access to these services was very limited. The Community Mental Health Act of 1963 was 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 numbers of counselors.

As the counseling profession grew, there came 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. It focused on counselor licensure. This began the steps toward the first counselor licensure law in Virginia in 1976. In the 1980s, mental health counseling had clearly established itself as a profession with a distinct set of regulations and methods to providing services. According to Gerig (2014), distinct professionals are characterized by “role statements, codes of ethics, accreditation guidelines, competency standards, licensure, certification, and other standards of excellence” (p. 32). 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.

As of May 2016, the Department of Labor identified almost 140,000 Licensed Mental Health Counselors (LMHCs), also referred to as Licensed Professional Counselors (LPCs). With professional designation now recognized in all 50 states the clinical mental health counseling field is poised to make an even larger positive impact in communities and the nation.

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