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

 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..  In mo

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 psychopahtology,

psychopharmacology, treatment planning, addictions, marriage and family, and more.

 2009 CACREP standards did away with the 48 hour community

 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 (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

 Turn of 20 th century

 Emotional problems seen as psychological in nature

 Freud—1 st 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

 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 psychotropics

 1960s

 Upheaval in American Society

 More social programs: Johnson’s “Great Society”

 1963: Community Mental Health Centers Act

 1980s to 1990s

 Reagan’s Block Grants limited some services

 Expansion and diversification of field

 More diversification of settings

 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)

 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

MOST COMMON ROLES

 Other, Less Common

 Another classification of roles and function:

 Primary, Secondary, and Tertiary Prevention

▪ Primary: Prevention and wellness

▪ Secondary: Control of nonsevere emotional problems

▪ Tertiary: Control of serious mental health problems

▪ See Figure 17.1, p 587

 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.

 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

 HMOs, PPOs, and EAPs

 Association: AMHCA

 Military and Government

 Association: AMHCA; ACEG

 See Box 17.3, p 592

 Pastoral, Religious, and Spiritual Agencies

 Association: AMHCA, ASERVIC, AAPC

 See Box 17.4, p 592

 Private Practice Agencies

 Association: AMHCA

 See Box 17.5, p 595

 Rehabilitation Agencies

 Associations: ARCA; NRCA

 Residential Treatment Centers

 Associations: AMHCA; ARCA, NRCA

 See Box 17.6, p 597

 Substance Abuse Settings

 Associations: AMHCA, IAAOC

 Youth Service Agencies

 Associations: AMHCA; ASCA

 Other Settings?

 Clinical mental health counselors need to be aware of following:

1 Clients from nondominant groups are under represented 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

 Assessment of Clients at Agencies

 Be careful about bias in tests

 Remember, that to some degree, diagnoses are culturally predisposed

 Consider “culture-bound” diagnoses

 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

 Ethical Issues

 Ethical Complaints and Ethical Concerns

 Ethical complaints made against LPCs (Neukrug, et al (2001):

• 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

 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

▪ 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

 Professional Issues

 Credentialing

▪ 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

 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

 Legal Issues

 Confidentiality of Records Assured by:

▪ 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

 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

 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