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Chapter 17
Clinical Mental Health Counseling
© 2016. Cengage Learning. All rights reserved.
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What Is Clinical Mental Health
Counseling?
 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 psychopathology,
psychopharmacology, treatment planning, addictions, marriage
and family, and more.
 2009 CACREP standards did away with the 48 hour community
counseling program
 CACREP requires 60 credits for Clinical Mental Health Counseling
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What Is Clinical Mental Health
Counseling?
 In most states, if you don’t go through a CACREP-accredited
program you can still get licensed
 Most states require that you have 60 credits in Clinical
Mental Health Counseling (regardless of specialty area) 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. 549: What a Long Strange Road Its Been
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History of Clinical Mental Health
Counseling
 Turn of 20th century
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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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History of Clinical Mental Health
Counseling
 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
 1950s
 Mental Health Study Act of 1955
 Expansion and acceptance of mental health services
 Widespread use of psychotropic medication
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History of Clinical Mental Health
Counseling
 1960s
 Upheaval in American Society
 More social programs: Johnson’s “Great Society”
 1963: Community Mental Health Centers Act
 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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History of Clinical Mental Health
Counseling
 1980s to 1990s
 Reagan’s Block Grants limited some services
 Expansion and diversification of field
 More diversification of settings
 Most Recently
 Advocacy of ACA, AMHCA, and NBCC to ensure clinical mental
health counselors are included as providers
 Gradual acceptance of diagnosis and psychopharmacology (see
Table 17.1, p. 553)
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History of Clinical Mental Health
Counseling
 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
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Roles and Functions of the
Clinical Mental Health Counselor
Most Common Roles
 Case manager
 Appraiser of client needs
 Counselor
 Consultant
 Crisis responder
 Supervisor/supervisee
 Supervisor/supervisee
 Accountability evaluator
 Other?
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Other, Less Common Roles
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Outreach worker
Broker/Networker
Advocate
Evaluator
Teacher/educator
Community planner
Administrator
Clinical assistant
Roles and Functions of the
Clinical Mental Health Counselor
 Another classification of roles and function:
 Primary, Secondary, and Tertiary Prevention
 Primary: Prevention and wellness
 Secondary: Control of non-severe emotional problems
 Tertiary: Control of serious mental health problems
 See Figure 17.1, p. 554
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Theory and Process of
Clinical Mental Health Counseling
 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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Settings Where You Find
Clinical Mental Health Counselors
 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. 558
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Settings Where You Find
Clinical Mental Health Counselors
 HMOs, PPOs, and EAPs
 Association: AMHCA
 Military and Government
 Association: AMHCA; ACEG
 See Box 17.3, p. 560
 Pastoral, Religious, and Spiritual Agencies
 Association: AMHCA, ASERVIC, AAPC
 See Box 17.4, p. 561
 Private Practice Settings
 Association: AMHCA
 See Box 17.5, p. 563
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Settings Where You Find
Clinical Mental Health Counselors
 Rehabilitation Agencies
 Associations: ARCA; NRCA
 Residential Treatment Centers
 Associations: AMHCA; ARCA, NRCA
 See Box 17.6, p. 565
 Substance Abuse Settings
 Associations: AMHCA, IAAOC
 Youth Service Agencies
 Associations: AMHCA; ASCA
 Other Settings?
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Multicultural/Social Justice Focus
 Clinical mental health counselors need to be aware of following:
1. Clients from non-dominant groups are underrepresented at mental
health centers
2.Clients from non-dominant 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
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Multicultural/Social Justice Focus
 Assessment of Clients: Testing and DSM-5
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Be careful about bias in tests
Remember, that to some degree, diagnoses are culturally predisposed
Consider “culture-bound” diagnoses
DSM-5 offers Cultural Formulation Interview (CFI) and defines some
cross-cultural symptoms; more cultural sensitivity
 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
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Ethical, Professional, and Legal Issues
 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
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Ethical, Professional, and Legal Issues
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Ethical Issues
 Perceptions of what is and is not ethical (see Table 3.2, p. 72)
 Counselors have little agreement about some situations
 Professional Issues
 AMHCA
 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
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Ethical, Professional, and Legal Issues
 Professional Issues
 Credentialing
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Certified Clinical Mental Health Counselor (CCMHC)
Master Addictions Counselor (MAC)
Nationally Certified Counselor (NCC)
Licensed Professional Counselor (LPC)
 Outlook and Salary
 Salaries can vary due to setting or region in which you live
 Median Salary: $41,500 (according to Occupational Outlook
Handbook)
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Ethical, Professional and Legal Issues
 Select 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.
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Ethical, Professional, and Legal Issues
 Legal Issues
 Confidentiality of Records Assured by:
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HIPAA
FERPA (Buckley Amendment)
Freedom of Information Act of 1974
Client’s rights to their records
 They have rights to view their records (except process notes)
 Parents usually have rights to view their children’s records
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Ethical, Professional, and Legal Issues
 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
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The Clinical Mental Health
Counselor in Process
 Growing, Changing, Accepting
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The ever-increasing acceptance of diagnostic tools such as DSM-5
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
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