Clinical Mental Health Counseling
Professional Credentialing and Standards:
A Historical Perspective
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Foreword
This presentation is a "Call to Awareness" to all Clinical Mental Health Counselors. It is intended to provide education to CMHC's as to the foundation, roots, goals, aspirations, and buidling blocks of their profession. It reviews the history of how these aspirations got muddled due to the frailty and fallibility of leaders, organizations and institutions. This call is to get the Clinical Mental Health Counseling Profession back on track by educating ourselves as to what are the pitfalls, traps, and conflicts which need to be avoided so that in the future the Profession can stay back on track and remain there in perpetuity.
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Clinical Mental Health Counseling Standards
In 2011 the American Mental Health Counselor's Associatiion (AMHCA) published its latest edition of its Standards for the Practice of Clinical Mental Health Counseling. It is the revision of standards which were first adopted in 1979, which were written in the establishment of National Academy of Clinical Mental Health Counselor (NACCMHC) (these standards are listed below in the Early Beginnings Section) and then revised in 1992, 1993, 2003, finally in 2011.
What is satisfying to see is that these standards incorporate the issues of: 1) Evidenced Based Practices, 2) Psychopharmacology, 3) Neuroscience 4) Multicultural Competencies for Clinical Mental Health Counselors and many of the principles involved in 5) Behavioral Medicine. Now what is needed is for the Accreditation Body CACRPEP to adopt these standards for its 60 graduate hour Clinical Mental Health Counseling Accreditation Standards.
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Early Beginnings
In 1976 when Nancy Spisso and Jim Messina (this author) were in the process of founding the American Mental Health Counselors' Association as a division of the American Counseling Association (at the time known as the American Personnel and Guidance Association) we had no idea how complex a task it would be to create a new profession with the Mental Health Counseling identity. As we progressed in the journey, Nancy chose to move on leaving me with the task of incorporating AMHCA into full division status with ACA and to also take the steps to insure the professional identity for Mental Health Counselors.
Weikel, W. J. (1985). The American Mental Health Counselors Association. Journal of Counseling and Development 63 (7) 457-460. Click here to view article
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Early Perceptions of Credentialing in the Counseling Profession
In 1977 after AMHCA was founded two articles appeared in the then APGA's Personnel and Guidance Journal. The first article (Forster, 1977) reviewed the various forms of credentialing including 1) Accreditation; 2) Certification; 3) Licensure. In this article the author pointed out that over 50% of the graduates of Counselor Education Programs at the time did not intend to work in schools which was the primary place of employment for which most Counselor Education Programs prepared their students. The article pointed out that many counselors were working various settings including private practice and serving the same clientele who were in the past served by Psychologists and Social Workers and since the counseling field had relied so much on the methods of psychology, psychiatry and other behavioral sciences it was hard to distinguish these counselors from the other professions due to a lack of appropriate credentialing. There was a need for credentialling but at the time clarity as to the way to go was lacking.
Also in 1997 the second article (Arbuckle, 1977) discussed the issue of licensure and interest was focused on licensing counselors in schools. At the time counselor educators were focused on training school counselors and this article clearly demonstrated a lack of awareness that so many of the counseling students were going on into fields far afield from the school counseling positions they were being trained to enter. AMHCA clearly emerged on the scene to address those counselors who strayed from schools into the mental health counseling field.
In 1978, The American and Personnel Guidance Association published an update on its efforts to promote licensure for professional counselors (Cottingham & Warner, 1978). Their rationale for the need for licensing of professional counselors was that if counselors were to be subject to their own control of their professional work rather than to the control of other professionals (say Psychologists or Social Workers), it was imperative that counselors develop some form of legislative recognition (that is state licensure).
Forster, J.R. (1977).. What Should We do about Credentialing? Personnel and Guidance Journal, 55(10):573-576. Click here to view article
Arbuckle, D. S. (1977). Counselor Licensure: To Be or Not to Be. Personnel and Guidance Journal, 55 (10) 581-585. Click here to view article
Cottingham, H.F. & Warner, R.W. (1978). APGA and Counselor Licensure: A Status Report. Personnel and Guidance Journal, 56 (10) 604-607. Click here to view article
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Roadmap for the Professionalization of Mental Health Counselors
In Spring of 1978, ACA formally recognized AMHCA as an official division and I became the first President of AMHCA in this divisional status with ACA. We soon recognized that it would be an uproad journey to get Mental Health Counseling recognized as a legitimate profession not only within the counseling community but also in the broader Mental Health community. To advance this goal, I set out with the assistance of the first Board of DIrectors of AMHCA to establish a roadmap which could be followed to insure the long term professionalization of the mental health counseling field.
First Gary Seiler and I wrote an article about the Mental Health Counseling Identity which appeared in the first edition of the Mental Health Counseling Journal in 1979.
Seiler, G. & Messina, J.J. (1979). Toward Professional Identity: The Dimensions of Mental Health Counseling in Perspective. American Mental Health Counselors Association Journal, 1 (1) 4-8. Click here to view article
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In that same 1979 journal AMHCA published my call for National Certification for Mental Health Counselors which resulted in the establishment of the National Academy of Certified Clinical Mental Health Counselors.
Messina, J.J. (1979).Why Establish a Certification System for Professional Counselors? A Rationale. American Mental Health Counselors Association Journal, 1 (1) 9-22. Click here to view article
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Finally to set the stage for the creation of the National Academy of Certified Clinical Mental Health Counselor we compiled standards for the practice of clinical mental health counseling. We used initially the title Professional Counselor, but chose to change the name to Clinical Mental Health Counselor to differentiate ourselves from other professional counselors who did not work in the clinical mental health field. These standards have been revised over the years and in 2011 AMHCA published its latest edition of these standards which are located at the top of this page.
Messina, J.J., Breasure, J., Jacobson, S. Leymaster, R., Lindenberg, S. & Scelsa, J. (1979). The Board of Certified Professional Counselors Procedures. American Mental Health Counselors Association Journal, 1 (1) 23-30. Click here to view article
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National Certification for Clinical Mental Health Counselors Used to Promote LMHC Licensure and Establishment of the National Board for Ceritified Counselors (NBCC)
In 1985 the history of the National Academy of Certified Clinical Mental Health Counselors (NACCMHC) was published in the then Journal of Counseling and Development (Messina, 1985). In this article I pointed out that the National Certification standards of the NACCMHC were utilized in the writing of the Licensure Law in the State of Florida in 1980 which was fully enacted in 1982. The goal of using the Academy's standards was to hopefully have all fifty states utilize the same standards to insure that the field of Clinical Mental Health Counseling had consistent standards in all 50 states. At the same time the Academy got underway, it assisted APGA leaders to establish the National Board for Certified Counselors (NBCC). Many of the procedures of NBCC were adapted from the NACCMHC's. NBCC's History was also published in the 1985 Journal (Stone, 1985)
Messina, J.J. (1985). The National Academy of Certified Clinical Mental Health Counselors: Creating a New Professional Identity. Journal of Counseling and Development 63 (7) 607-608. Click here to view article
Stone, L.A. (1985). National Board for Certified Counselors: History, Relationships, and Projections. Journal of Counseling and Development 63 (7) 605-606. Click here to view article
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Early Perceptions of State Licensure for Professional Counselors
In a 1981 Snow demonstrated that at that time Counselors and Psychologists were in favor of separate licensure for counselors from that of psychologists. Counselors wanted more control of their own profession and wanted to insure their independence from oversight of psychologists. In the same Journal Davis presented an oppositional point of view toward licensure for counselors. By 1981 four states had licensed professional counselors they were Virginia, Arkansas, Alabama and Texas. All had LPC's. It was in 1982 when the first LMHC law was enacted in Florida.
Davis (1981) in the same journal warned counselors not to use licensure to "overkill" and that National Certification such as the NACCMHC was an excellent alternative to protect society and to promote the competency of Clinical Mental Health Counselors. Davis also pointed out that Licensure was a sign that Counseling had moved from an occupation to a profession. Swanson (1981) reported on research in Oregon as to counselors favorable opinions concerning the need for licensure in that state. Huber (1982) reviewed a proposal for a model licensure model which would use competency based measures to qualify counselors for licensure in their states. The proposal also would require better self-disclosure by these licensed counselors as to their academic and professional training and areas of expertise to better protect the public. Edgar and Davis (1983) pointed out how the licensing bill in Idaho was passed by pushing the answer to two issues: 1) a bill which insured licensed counselors in the state would be bound by a single code of ethics and 2) a bill which would provide a means by which abuses by the licensed professionals could be investigated and adjudicated.
Clearly in the early days of state licensure for counselors, the profession was still searching for a route to take to clarify the professional role and function of counselors in all states through licensure. Most of the efforts however disregarded the efforts of the NBCC and NACCMHC as they pursued their state regulations.
Snow, B. M. (1981). Counselor Licensure as Perceived by Counselors and Psychologist. Personnel and Guidance Journal, 60 (2) 80-83. Click here to view article
Davis, J.W. (1981). Counselor Licensure: Overkill? Personnel and Guidance Journal, 60 (2) 83-85. Click here to view article
Swanson, J. (1981). Moving Toward Counselor Licensure: A Statewide Survey.
Personnel and Guidance Journal, 60 (2) 76-79. Click here to view article
Huber, C. H. (1982). Licensure in Counseling: An Alternative Direction. Personnel and Guidance Journal, 61 (4) 246-248. Click here to view article
Edgar, T. E. & Davis, E.L. (1983). A Proven Approach to Licensure. Personnel and Guidance Journal, 62 (2) 70-72. Click here to view article
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Roots of the Muddled Road to Professional Identity for CMHC's
At the Beginning of the 1990’s professional counselors were encouraged to move for a generic Counselor Credentialing and to leave the issue of specialty credentialing to the NBCC and the NACCMHC. They pushed for states to adopt the Licensed Professional Counselor license ignoring the efforts of the NACCMHC and the State of Florida’s LMHC model which would have promoted the Profession of Clinical Mental Health Counseling in a more proactive way. As a result of this effort in the 90’s the profession of Clinical Mental Health Counseling has had a confused and non-standardized model of licensure in the 50 states.
Bloom et al (1990) presented the Model Licensure standards for the LPC’s. They assumed that specialties in counseling such as the Clinical Mental Health Counselors would be better served by the National Certification bodies of the NBCC and the NACCMHC which eventually became part of the NBCC.
Brooks and Gerstein (1990) again pushed for the LPC ignoring completely that the Licensed Counselors who serve clients in need of mental health services in the state needed Clinical Mental Health Counselors who were licensed, regulated and monitored by State Boards. This LPC model continued to muddle the identity issue for the actual mental health counselors who worked in mental health agencies and private practices. AMHCA did not advocate strongly enough to stop this effort unfortunately. Most telling was the response to Brooks and Gerstein by Metcalf, Dean & Britcher (1991), who countered the proposition that counselors were trained to diagnose and treated clients with mental illness. They claimed that their Counselor Education Programs did not train them to work with such clientele and that it was only until they got out into the work field did they learn how to deal with such conditions and clients. This was truly a “red flag” which unfortunately was ignored by both ACA and AMHCA and the move towards an unfocused understanding of the Professional Identity; of Clinical Mental Health Counselors was pushed further and further back. This article alone should have been a wakeup call for Counselor Educators to move towards the 1986 CACREP standards for Clinical Mental Health Counselor Training which was not well received by Counselor Educators at the time.
Bloom, J., Gerstein, L. , Tarvydas, V., Conaster, J., Davis, E., Kater, D., Sherrard, P. & Esposito, R. (1990). Model Legislation for Licensed Professional Counselors. Journal of Counseling and Development 68 (5) 511-523. Click here to view article
Brooks. D. K. & Gerstein, L. H. (1990). Counselor Credentialing and Interprofessional Collaboration. Journal of Counseling and Development 68 (5) 477-484. Click here to view article
Metcalf, H.E., Dean, D.M. & Britcher, J.C. (1991). In Response to Brooks and Gerstein: Mental Health Counseling is More Diverse Than You Imply. Journal of Counseling and Development 69 (5) 469-471. Click here to view article
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Ambivalence towards Professional Credentialing in the early 90's
The rest of the first half of the 90’s found authors encouraging credentialing but lacking in a full appreciation for the need to pull in the ranks behind a single identity for counselors who worked in the Mental Health Field. VanZandt (1990) encouraged counselors to get on the professionalization bandwagon, but unfortunately he did not seem to grasp the impact of the hallmarks of a profession which needed to be encouraged. Anderson (1992) encouraged standards in the counseling profession which included sound disclosure statements to clients with sound ethical practices in the provision of such services. Alberding, Lauver & Patnoe (1993) had researched counselor’s awareness of the positive and negative consequences of state licensure regulations for counselors and found that most counselors at the time had no clear understanding of the impact of licensure and that there was a need for increased education for the professionals. This of course in retrospect demonstrated the lack of tradition in the counseling field of having national certification or licensure and thus not including healthy discussion of the impact of this movement on the professional field. Finally to support the lack of sophistication of the understanding of the rationale and impact of national certification, Weinrach and Thomas (1993) exposed their lack of acceptance for national certification of counselors by taking on the NBCC. Unfortunately there has never been any work done to clarify the value and worth of national certification of counselors now that states license them. This is a shame given National Certification is a hallmark which was proposed by me (Messina, 1979) when AMHCA came out with the NACCMHC plan of action and their national standards.
VanZandt, C. E. (1990). Professionalism: A Matter of Personal Initiative. Journal of Counseling and Development 68 (3) 243-245. Click here to view article
Anderson, D. (1992). A Case for Standards of Counseling Practice. Journal of Counseling and Development 71 (1) 22-26. Click here to view article
Alberding, B., Lauver, P. & Patnoe, J. (1993). Counselor Awareness of the Consequences of Certification and Licensure. Journal of Counseling and Development 72 (1) 33-38. Click here to view article
Weinrach, S. G. & Thomas, K.R. (1993). The National Board for Certified Counselors: The Good, the Bad, and the Ugly. Journal of Counseling and Development 72 (1) 105-109. Click here to view article
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A Call to Action by the Orlando Project
In 1995 under the leadership of AMHCA's then President Roberta Driscoll Marowitz, The Orlando Project called for a revitalization of the Hallmarks of the profession for Clinical Mental Health Counselors by the establishment of the National Commission for Mental Health Counselors. This effort was aimed at identifying the competencies needed by Clinical Mental Health Counselors to do their work well and to insure that future Clinical Mental Health Counselors would not only have excellent competency based graduate programs but ongoing competency based continuing education programs and Evidence Based Treatment Research driven publications. Altekruse and Sexton (1995) published their reseearch on the identification of competencies as perceived by current CMHC's practitioners. In that Monograph, I wrote about the purpose of the Orlando Project (Messina, 1995) as well as about goals and purpose of the National Commission for Clinical Mental Health Counselors (Messina, 1995). Unfortunately, at that time, AMHCA was making moves to become a freestanding Association with its own central staff and did not choose to suport the establishment and continued support of the National Commission. With this stoppage of the National Commission, efforts to resurrect the getting back on the right track towards the professionalization of Clinical Mental Heatlh Counseling Profession took a step back.
Altekruse, M. K. & Sexton, T.L. (1995). Mental Health Counseling in the 90’s: A Research Report for Training and Practice. Tampa, FL: National Commission for Mental Health Counseling. Click here to view article
Messina, J.J. (1995). Introduction to Orlando Model Series Monographs in: Altekruse, M. K. & Sexton, T.L. (1995). Mental Health Counseling in the 90’s: A Research Report for Training and Practice. Tampa, FL: National Commission for Mental Health Counseling.. Click here to view article
Messina, J.J. (1995). The Historical Context of the Orlando Model Project and the NCMHC in: Altekruse, M. K. & Sexton, T.L. (1995). Mental Health Counseling in the 90’s: A Research Report for Training and Practice. Tampa, FL: National Commission for Mental Health Counseling. Click here to view article
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Complacency versus Call to Action in Getting the Profession of Clinical Mental Health Counseling Back on Track
Smith and Robinson (1995) gave an interesting watered down perspective on the progression of the profession of Clinical Mental Health Counseling. It was clear from the title that by leaving out the term "Clinical" they were not on board with the original vision, trajectory or goals of setting up the profession of Clinical Mental Health Counseling, despite the fact that both of them were past presidents of AMHCA. Adding to this complacency, Sweeney (1995) talked about Accreditation with not major promotion to Counselor Education Programs to get on board with the CCMHC training standards which came into existance in 1986 with less than 20 programs nationally adopting it.
In 1999, two ex-presidents of AMHCA pleaded with the Association to get back on track to push the profession of Mental Health Counseling to its anticipated and desired fruition. Beck (1999) spoke of success 1998 when mental health counselors received an encouraging word in their quest for national professional recognition, when Congress passed S1754 and President Clinton signed the Health Professions and Partnership Act, which included graduate students in counseling as eligible for grants under the Clinical Training Program of the Center for Mental Health Service (CMHS) and mandates that the Health Resources and Services Administration (HRSA) recognize professional counselors as "core mental health providers," making professional counselors [not named mental health counselors] eligible to participate in thc National Health Service Corps (NHSC) Scholarship and Loan Repayment Program. It is interesting that in 1998 as Beck pointed out Clinical Mental Health Counselors was not the identification used by the lobbyists from ACA and AMHCA, clearly as a harbinger of rougher roads ahead for the professionalization of the field of Clinical Mental Health Counseling.
Beck (1999) went on to point out that the causes for the slow pace in the professionalization of the CMHC Profession were five core areas where conflict and confusion existed up to that point in time. They were conflicts as to:
- An acceptance of a common unique definition of mental health counseling professional practice by members and leaders despite organizational pronouncements
- An acceptance of a common unique professional identity for mental health counselors by the various professional counseling organizations, members, and legislatures
- An acceptance of a universally accepted set of training and legal standards for mental health counselors by states in certification and licensure
- An acceptance of a universally accepted professional organizational structure to represent those doing mental health counseling, those who train them, and those who certify them
- Leadership factions causing internal dissension, abandonment of organizational growth, and setbacks in the shared professional aspirations of the all-important membership.
Beck went on to call all AMHCA members and leaders to get back on track so as to bring the Profession into a better place.
At the same time and in the same journal, I wrote an article (Messina, 1999) which called AMHCA membership and leadership to get back on track with the original six pillars of the profession I had posited in 1979 which are:
- Naitonal Voluntary Professional Membership Organization (AMHCA)
- National Standard for recognition of competent professional via a National Certification process which is the Certified Clinical Mental Health Counselor (CCMHC) awarded by the Academy of Certified Clinical Mental Health Counselors which is an arm of the NBCC
- National accreditation standard for the educational and training of Clinical Mental Health Counselors (which at that time was CACREP's CMHC's Standards which only had 17 programs accredited as such)
- Uniform standard of licensure in all 50 states for Clinical Mental Health Counselors (which at that time was muddied due to the LPC's vs LMHC licensures in various states around the the Union
- National standard of clinical standards and professional competencies (Knowledge, Skills, and Abilities) which are the foundation for the profession's national certification, national accreditation and state by state licensure.
- Body of research and theory about the practice of Clinical Mental Health Counseling, which distinguisheds this profession from the other professions that are engaged in similiar work efforts.
Clearly in 1999 things were very muddled and confused. The national Certification and National Accreditation as well as the State Licensure movement were not in line with the unified perspective these six pillars of the profession would have accomplished. To no surprise this call to reorganize and get back to using these pillars as building blocks for the future was ignored.
Ten years later, Colangelo (2009) presented a revisionist history of AMHCA which seemed to ignore the early foundation which was put into place in AMCHA's first decade. Instead it presented AMCHA as as strong and vibrant profesional organization despite the fact that there was no real movement in accomplishing a unified national identity, national recognition, nor national respectability for this young aspiring mental health profession.
In 2010, Martin and Cannon called for changes in the Training of Counselors given that the largest percentage of Counselor Educators in Tennessee at the time were psychologist (36%); social workers (5%); MFT's (7%); and with no Identifiable mental health training (49%). Only 4% were counselors. Clearly their call for Counselors training Counselors utilizing the CACREP standards made sense given the need for the profession to be nurtured by members of the profession itself. This issue alone explains how the professionalization of Clinical Mental Health Counseling got off track since its founding in 1976.
Smith, H. B. & Robinson, G. P. (1995). Mental Health Counseling: Past, Present, and Future. Journal of Counseling and Development 74 (2) 158-162. Click here to view article
Sweeney, T. J. (1995). Accreditation, Credentialing, Professionalization: The Role of Specialties. Journal of Counseling and Development 74 (2) 117-125. Click here to view article
Beck, E. (1999). Mental Health Counseling: A Stakeholder’s Manifesto. Journal of Mental Health Counseling 21 (3) 203-225. Click here to view article
Messina, J. J. (1999). What’s Next for the Profession of Mental Health Counseling? Journal of Mental Health Counseling 21 (3) 285-294. Click here to view article
Colangelo, J. J. (2009). The American Mental Health Counselors Association: Reflection on 30 Historic Years. Journal of Counseling and Development 87 (2) 234-240. Click here to view article
Martin, F. A. & Cannon, C. (2010). A Profession in Peril. Counseling Today, May 2010, 50-53. Click here to view article
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What is being said at Present about the Professionalization and Credentialing of Clinical Mental Health Counselors?
In 2012, I was requested to give the keynote to the Florida Mental Health Counselors Association. In 2013, I was requested to give the keynote to the Utah Mental Health Counselors Association. Both talks were on the Future of Mental Health Counseling with a Historical Perspective. These two talks and reference materials are saved on this website at:
From these two talks came the proposal to Put Health Back into Clinical Mental Health Counseling. The goal is to get all licensed professional counselors and licensed mental health counselors to become CCMHC's so as to create the national credential which not only provides a commitment of Clinical Mental Health Counselors to a common core of clinical standards, ethics and clinical practice but provides the community with a tool by which then can identify how Mental Health Counselors differ from the other mental health professions. A second benefit of this effort would be to assist licensing boards to have a national standard they could incorporate into their state board regulations to assist in the transportability of licenses from state to state. This effort with the CCMHC would also provide such groups as the VA and Tricare with an alternative path to entrance for professionals who had graduated from Counselor Education Programs which were not Clinical Mental Health Counseling CACREP approved programs.
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Afterword
If you have taken the time to read all of the historical documents presented and gotten to better understand what the goal was in presenting them, then go out there, be advocates, be leaders, be courageous and bold and take up the fight to make the Clincial Mental Health Counseling Profession the best that it can be.
Thanks
Jim Messina, Ph.D., CCMHC, NCC and an AMHCA co-founder, past-president and dinosaur
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