Coping.us

Professionalization of the Field of Clinical Mental Health Counseling

Chapter 3:

AMHCA: The Professional Association for Clinical Mental Health Counselors

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS

& Ed Beck, ED.D, CCMHC, NCC, LPC

Place of Mental Health Counseling in the Bigger Picture of the Other Mental Health Professions

It would be wise to take a step back and look at the historical perspective of the mental health professions prior to looking at the status of the Mental Health Counseling's Professional home of the American Mental Health Counselors Association (AMHCA).

The Professions in the Mental Health Field are:

1.Psychiatry (including: Psychiatric Nurse Practitioners, Psychiatric& Physician Assistants

2.Psychology

3.Social work

4.Marriage and Family THerapist

5.Clinical Mental Health Counselors

1. Psychiatrists

The field of psychiatry began in the 18th Century. In the 1970’s Biological Psychiatry emerged.

The heavy emphasis in Psychiatry today is the diagnosing and treatment mental illness and psychopharmacology is the preferred course of treatment for most psychiatrists. Aids working with psychiatrists or working Independently are ARNP-Psychiatric Nurse Practitioners and Psychiatric Physicians Assistants who assist in the prescribing of medications to treat their patients.

2. Clinical Psychologists

Psychology as a field emerged in the early 20th Century with emphasis on Assessment. There are two types of Psychologist degrees:

Ph.D. scientist–practitioner model - requiring a doctoral dissertation and extensive research experience in addition to clinical expertise
Psy.D. practitioner–scholar model - requiring completion of either a dissertation or other doctoral project, with extensive focus on clinical expertise in addition to research

Clinical psychologists provide psychotherapy, psychological testing, and diagnosis of mental illness.

3. Clinical Social Workers

The field of Clinical Social Work emerged in the mid 19th Century. The main tasks of professional clinical social workers (MSW's) are:

Case management - linking clients with agencies and programs that will meet their psychosocial needs)
Counseling and psychotherapy, assessment and diagnosis of mental disorders
Child protection/welfare and, human services management

4. Marriage and Family Therapists

The field of Marriage and Family Therapy evolved in the early 20th Century with the emergence of the child guidance movement and marriage counseling. The formal development of family therapy dates to the 1940s and early 1950s with the founding in 1942 of the American Association of Marriage Counselors (the precursor of the AAMFT). Heavy emphasis of Marriage and Family Therapists is on couples therapy, marriage therapy, and family therapy.

5. Clinical Mental Health Counselors

The field of Mental Health Counseling was rounded in 1976 when the American Mental Health Counselors Association (AMHCA) was established as a Division of the American Counseling Association (ACA which was known as APGA at the time). •Diagnosis and treatment of Mental illness through Individual, group and family therapy are the therapeutic goals fo these professionals. The mental health counseling profession although the youngest is the fastest growing Mental Health Profession in the USA.

With this timeline overview, it becomes important to remember in reviewing the current status of the Mental Health Counseling Profession and its Professional Association AMHCA that in 2016, it was only 40 years old. When compared with the other professions and associations it has come a long way in a short period of time. With its growing pains it has learned lessons which hopefully will be applied as the profession enters a new era in the mental health field with the growth of Integrated Medicine and Behavioral Care. Also needing the profession's attention is the gaining of the Federal status as Core Providers and Medicare coverage which it needs to address to secure its stability and future in the next decade before its 50th birthday.

Why Professionals should join their Professional Associations

What is a profession you might ask, when you look at this first pillar of the Clinical Mental Health Counseling Profession. A professional association is the visionary proactive stimulus for the growth of professionalism in a profession. Association driven professionalism requires professionals to be worthy of trust, to put clients first, to maintain confidentiality and not use their skill and knowledge about their clients for fraudulent purposes. In return for professionalism in client relations, such professionals are rewarded with respect, recognized competence and held in high regard (Evetts, 2011). Professional associations in are critical for generating the energy, flow of ideas, and proactive work needed to maintain a healthy profession that advocates for the needs of its clients and professionals (Matthews, 2012). A professional association also has the obligation to advance the profession in terms of policy development and advocacy and benefit for consumers, society and the profession. (Myers, Sweeney & White, 2002).

A quick summary of the benefits of joining professional associations at the local, state and national level are: 1) Education through oversight of academic accreditation and professional journals to share the latest information on the latest effective treatments and innovations in the field; 2) conventions and conferences and training programs; 3) networking; 4) oversight of the credentialing in the field with national certification, state licensure and academic accreditation; 4) career assistance and 5) informative websites and social media outlets (Greggs-McQuilkin, 2005). Also it is a well-accepted fact that most professional associations provide a vehicle for sharing knowledge, set educational, training and ethical standards. (Myers, Sweeney & White, 2002).

Another benefit of joining a professional association is the promotion of professionalism in the field. Research has demonstrated that practical knowledge, experience and knowledge in use were hallmarks of professionalism in mental health professional organizations over theoretical knowledge and formal education which is what many would expect (Svensson, 2006). The credentialing standards and accreditation culture and history of The American Mental Health Counseling Association (AMHCA) is an important example of this reality in that having a Ph.D. or Ed.D. is not seen as a sign of professionalism as are: having a CACREP Clinical Mental Health Counseling Master’s Degree, being a Licensed Mental Health Counselor (LMHC) and being a Certified Clinical Mental Health Counselor (CCMHC). AMHCA promoted the concept of being a “competent clinician with practical applicable skills” over a high trained theoretician model for professional excellence.

Alotaibi (2007) stated that factors which influence professionals to join their respective professional association are: self-improvement, education, new ideas, continuing education programs, professionalism, validation of ideas, and improvement of personal effectiveness on the job and maintenance of professional standards/

Joining professional associations at the local, state and national level for new CMHCs is important because it can provide tools which ease transition from student to CMHC. Professional associations are there to foster professional growth of new professionals and it is important for those new to a profession to bring their professional needs with them into professional organizations which foster their professional growth (Martin, 2007).

“Unlike such professions as law, for which the professional association controls entry into the profession via bar exams, thereby virtually guaranteeing 100% membership, joining a counseling association is a voluntary decision”(Bauman, 2008, p. 86). Bauman researched the reasons why School Counselors join their association the American School Counseling Association and the following table is based on data provide in her study:

Comparison of Numbers of Professionals

Who belong to their National Professional Organizations

# Professionals in Field (U.S. Bureau of Labor Statistics in 2002)	# Professions in Related Professional Organization in 2005	Rate who are members of their Respective Organization in 2005
526,000 Counselors	43,869 in ACA	8%
122,000 Rehab Counselors	740 in ARCA	Minuscule%
85,000 Mental Health Counselors	6,000 in AMHCA	7%
67,000 Substance Abuse Counselors	921 in IAAOC	Minuscule%
23,000 Marriage & Family Therapist	2,344 in IAMFC	10%
129,460 School counseling	14,000 in ASCA	11%
139,000 Psychologists	155,000 in APA	+ 100%
25,000 School Psychologists	21,000 in NASP	84%
4 million Teachers	2.7 million in NEA	67%

It is clear in reviewing this data from 2002 and 2005 which Bauman (2008) used it is a clear statement that counselors as professionals are not driven to become members of their respective national professional associations. This is a problem for both counseling professionals and their professional associations in terms of professional identity, advancement, consumer awareness and public policy, especially for the Clinical Mental Health Counseling Profession which in 2010 was listed to have 120, 000 mental health counselors licensed either as LMHC’s or LPC’s and only 7,300 are members of AMHCA. In fact, the lack of professional recognition as a core provider group of mental health services in public policy legislation in arenas such as Medicare and the Affordable Health Care act provisions could possibly be because of these disparities. Bauman’s (2008) research found that when graduate programs stress the value of joining professional organizations, that encouragement is associated with increased interest in membership. Students may be influenced by the particular organizational memberships recommended (and modeled) by faculty. When faculty are members of the organization of the Specialty for which they are training their students may see alternative associations as less important, or vice versa. Faculty may also overemphasize the particular value of these organizations for student members, inadvertently communicating that when one graduates, the importance of membership is less salient (Bauman, 2008).

The reality is that AMHCA is the “Little Engine that Could” which climbed the mountain of establishing itself as a credible mental health profession and today it has its practitioners recognized by state statute and licensure in all fifty states and is working on gaining parity with Clinical Psychology, Clinical Social Work and Marriage and Family Therapists in those states where they are licensed as Mental Health Counselors. Currently over 100 Counseling Departments have gained CMHC CACREP accreditation and because of the standards established by the Certified Clinical Mental Health Counselor national certification and which requires its NCMHCE exam, the Institute of Medicine in Washington has recognized Clinical Mental Health Counselors as the standard bearers for counselors in the mental health field of VA and Tricare which hopefully will translate into recognition for Medicare as well. However, this recognition has been a long time in coming and without stronger professional and consumer advocacy, this kind of recognition may be a long way off despite small gains.

There is another point of view as to why graduates of professional training programs choose not to join their respective professional organizations. Macejko (2009) reported that in a survey of professional graduates, they reported they would be interested in joining their professional association(s) if they knew about the association and how to join, saw its relevancy, could afford membership, felt welcomed and most importantly were personally invited. Clearly it is imperative that the word get out to CMHC training sites for the Trainers to join AMHCA at the local, state and national level and to invite their students and graduates to join them. In such invitation it is important to stress: Joining professional organizations like AMHCA and attending professional conferences can provide tremendous career development, skill-building, and professional networking opportunities (Mata, Latham & Ransome, 2010). “A very critical research question that needs to be asked if new professionals might be inclined to join the professional organization if they knew it provided successful career and professional advocacy activities in terms of their own career histories in terms of opening doors to a wider variety of career setting opportunities and enhanced compensation.

Status of Mental Health Professionals in the USA

In 2016 on the fortieth anniversary of the formation of the Mental Health Counseling Profession, a review was made of the status of Mental Health Counselors' employment in the mental health field in comparison to the other health professions. In the following graphs you will see that it has been difficult to delineate mental health counselors from the variety of other counselors. The data below comes from the Bureau of Labor Statistics of the US Department of Labor:

Figure 1: Department of Labor’s Statistics on the Number of

Mental Health Professionals in the United States as of February 2016

Profession	Number
Psychiatrists	49,079**
Psychologists	173,900**
Child, Family & School Social Workers(Clinical Social Workers)	286,520**
Healthcare Social Workers	145,920**
Mental Health and Substance Abuse Social Workers	109,460**
Social Workers, All Other	61,410**
Total Social Workers	603,310**
Marriage and Family Therapist	30,150**
Mental Health Counselors	120,000**
Substance Abuse & Behavioral Disturbance Counselors	85,180**
Rehabilitation Counselors	103,890**
All other Counselors	28,240**
Total Counselors	229,310

* According to the US Department of Labor’s Bureau of Labor Statistics 2014

** http://www.bls.gov/oes/current/oes210000.htm

Italicized Professionals Not used in computation of Involvement in Professional Organizations in the next Figure:

The second figure presents the current percentage of the mental health professionals who participate in their national organizations. For Social Workers the first category of Counselors used by the Department of Labor was used. For Mental Health Counselors the first category of Counselors used by the Department of Labor was also used.

Figure 2: Percentage of Participation of Mental Health Professionals in their National Professional Organizations as of February 2016

Profession	Numbers	Professional Association	Members	%
Psychiatrists	49,079**	American Psychiatric Association (APA)	36,000	73%
Psychologists	173,900**	American Psychological Association (APA)	137,000	79%
Child, Family & School Social Workers(Clinical Social Workers)	286,520**	National Association of Social Workers (NASW)	132,000	46%
Marriage and Family Therapist	30,150**	American Association of Marriage and Family Therapists (AAMFT)	25,000	83%
Mental Health Counselors	120,000**	American Mental Health Counselors Association (AMHCA)	7,000	6%

* According to the US Department of Labor’s Bureau of Labor Statistics 2014

** http://www.bls.gov/oes/current/oes210000.htm

As you can see by this chart that over the last decade there has not been a big swing in Mental Health Counselors joining their national organization. This is a sad fact which does not have any clear causation. The reality is that the mental health counseling field needs national and state level advocacy for the profession and the populations it serves. Hopefully licensed mental health counselors and licensed professional counselor along with counselor education programs will be able to encourage their students to take a more proactive role in their profession so as to give the next decade of Mental Health Counselors's a more solid foundation to work from.

Goals of Professional Associations

There are nine goals of Professional Associations for Professional in the Mental Health Field are: 1) Advocacy for the professional identity and its members; 2) Defining scope of practice for the profession, 3) Articulating specialities within the scope of practice for the profession; 4) Determining best practices, accreditation, credentialing and licensing standards for the profession at the local, state and federal level; 5) establishing ongoing professional development and continuing education guidelines for the profession; 6) Creating ethical standards for the profession; 7) Advocating for the public interest 8) Supporting and evaluating research to improve mental health treatment and 9) Develop association leadership, members and allied constituencies committed to these goals.

Goal 1: Promotion of Professional Identity

Saru’s research (2011) indicates that there is a lack of clarity by the public and others in differentiating among the professions of psychiatry, clinical psychology, clinical mental health counseling, clinical social work, and marriage and family therapists. Over the years of the growth of mental health services, this lack of clarity in the public’s mind makes the search for professional identity for each of these mental health profession all the more pronounced and daunting so as to establish their “place” or “role” in the mental health setting (Saru, 2011).

Providing a universally accepted unique and undiffentiated professional identify is typically one of the first goals of establishing Professional Association as seen in the histories of: Clinical Mental Health Counselors (Weikel, 1985; McCormick & Messina, 1987; Weikel, 1999; Colangelo, 2009); Professional Counselors (Herr, 1985); Counselor Educators (Elmore, 1985); College Personnel Specialists (Johnson, 1985); Rehabilitation Counselors ( DiMichael & Thomas, 1985); School Counselors (Minkoff & Terres, 1985); Employment Counselors (Meyer, Helwig, Gjernes & Chickering, 1985); Clinical & Counseling Psychologists (Cummings, 1990); Clinical Social Workers, 1990) and Marriage and Family Therapists (Everett, 1990). Frank Burtnett and Ed Beck worked diligently in the 1980’s to have the field of mental health counseling listed as a profession in the Occupational Outlook Handbook. Mental Health Counselors were included as a specialty profession in the “counseling category” as a “psychoeducational’ model for treating clinical mental health issues. It was the first time Mental Health Counseling was mentioned. Burtnett and Beck were cited in the OOH between 1980 and 1984.

A recurrent issue for CMHCs members of AMHCA has been the professional identity issue and of note in 2006 an editor of the AMHCA’s Journal of Mental Health Counseling said: “In a time when a focus on psychopathology and mental disorders is required for third-party reimbursement, it is increasingly possible that we may lose our identity as mental health counselors as mental health professionals who focus on facilitating human growth and development, conceptualize peoples’ situations from multiple perspectives, and use varied contextually sensitive theories and practice interventions in helping people to live healthy, full lives” (Kress, 2006).

This fear of loss of identity by being identified with treating clients who require diagnosis and treatment for severe mental health disorders is an interesting issue which does not seem to be in line with day to day work of CMHCs in the work world. For this reason it is imperative that CMHCs join AMHCA at all levels to insure their identity as Clinical Mental Health Counselors who do not shy away from diagnosing and treating individuals with severe mental health disorders. Given that is the work they are currently engaged in and need the appropriate training, credentialing and ethical and legal assistance to insure they are doing the best work they can for their clients and communities.

Research has shown that counselors who belong to their professional counseling associations identify with focus on developmental, prevention and wellness orientation in the helping other which creates a united identity across all of counseling specialty professions of which Clinical Mental Health Counseling is one. This research also found that counselors considered psychology as emphasizing testing and social work on focusing on systemic issues (Mellin, Hung & Nichols, 2011). Even though it is widely accepted in the mental health community that all three professions in their work with their clients engage in similar if not identical work of assessing, diagnosing and treating individuals with mental health concern (Mellin, Hung & Nichols, 2011).

Beck, Kaplan, Smith and Morocco, (2000) in a futuristic article at the time even suggested that because of all of the overlapping training and the confusion that existed in professional identity that all of the mental health professions be combined in terms of defining scope of practice and career tracks by virtue of education and training levels from associates degree, through bachelors level, through masters level, through doctoral level and medical level., in an effort to develop a comprehensive identity and unified professional development track.

Once a profession establishes its identity through its professional association it must be open and ready to work with fellow professionals in a collaborative fashion to address issues of organizing, managing, marketing, assessing and policy making to effectively create as reasonable and cost-effective mental health systems to address the needs of the public for years to come (Muzio & Kirkpatrick, 2011).

Lastly, there has been a call for collaboration among counselors from all specialties and associations to develop a single coherent message for advocacy efforts aimed at congressional Medicare leaders, managed care organizations, state licensing boards, and allied professions (Reiner, Dobmeier & Hernandez, 2013). AMHCA needs to step up tocollaborate to encourage all stakeholders in the Clinical Mental Health Counseling community become active by joining their professional organization and help draw in the other counseling professional associations to become a single voice which speaks in one accord for the mental health needs of their clients and mental health service providers who in the main are either Licensed Mental Health Counselor (LMHCs) or Licensed Professional Counselors (LPCs) who work in the mental health field.

Goal 2: Delineation of Ethical Conduct for its Members

All professional entities in the Mental Health field have codes of Ethics, the rational for this is stated in the preamble of the AMHCA Code of Ethics (2010):

AMHCA’s Code of Ethics Preamble

The American Mental Health Counselors Association (AMHCA) represents mental health counselors. As the professional counseling organization of mental health counselors, AMHCA subscribes to rigorous standards for education, training and clinical practice. Mental health counselors are committed to increasing knowledge of human behavior and understanding of themselves and others. AMHCA members are highly skilled professionals who provide a full range of counseling services in a variety of settings. Members believe in the dignity and worth of the individual and make every reasonable effort to protect human welfare. To this end, AMHCA establishes and promotes the highest professional standards. Mental health counselors subscribe to and pledge to abide by the principles identified in the Code of Ethics.

This code is a document intended as a guide to: assist members to make sound ethical

decisions; to define ethical behaviors and best practices for Association members; to support the mission of the Association; and to educate members, students and the public at large regarding the ethical standards of mental health counselors. Mental health counselors are expected to utilize carefully considered ethical-decision making processes when faced with ethical dilemmas (AMHCA, 2010)

Professional associations in the mental health field establish Codes of Ethics for their members so as to insure “no harm” is done to the clients these professionals and to instill in the public confidence in the profession (Knapp & Lemoncelli, 2005). Mental Health Professions need to address the follow ethical and legal issues in their field to insure healthy ethical conduct of their members:

Ethical and Legal Issues in Mental Health Treatment Provision

Basic Legal Concepts
Common Practice Issues
Confidentiality and Privilege
Requests for Information
Record Keeping
Termination of Services
Closing a Professional Practice
Fees and Billing
CMHCs in Legal Settings
HIPAA (Health Insurance Portability and Accountability Act of 1996) (COPPS, 2003).

Telehealth, and advances in technology are a major new arena demanding increased ethical oversight by mental health professional associations.. Clients, in this new technology era, need to have their privacy protected and the professionals working with them need new risk management procedures. Video teleconferencing, apps, “smart” mobile devices, cloud computing, virtual worlds, virtual reality, and electronic games are just a few technologies which new ethical guidelines need to be drawn up to insure client and provider protections in their use (Maheu, Pulier, McMenamin & Posen, 2012). Equipping future generations of mental health practitioners and clients to collaborate more successfully in all potential growth areas requires professional associations to increase their focus on technology in promotion of standards for graduate education, training, and supervision as well as in the provision of continuing education programs on the ethical utilization of this expanding technology entering the mental health field.

Goal 3: Delineation of Specialization among its Members

Providing a home for specialists who are delineated from other professionals in the field is a common goal of a professional pssociation as seen in: Group Therapy Specialists (Carroll & Levo, 1985); Multicultural Specialists (McFadden & Lipscomb, 1985); Humanistic Specialists (Wilson & Robinson, 1985); Corrections Specialists (Page, 1985); Vocational Specialists (Smith, Engels & Bonk, 1985); Medical School Psychologists (Silver, Carr & Leventhal, 2005); Family Psychology Specialists (Nutt & Stanton, 2008); School Psychology (Tharinger, Pryzwansky & Miller, 2008); Association for Psychological Science (APS) (Cautin, 2009); Health Service Psychologists (Belar, 2012).

Significantly in 2010 AMHCA “wanted the public and government officials to know that clinical mental health counselors are among the best-trained and qualified psychotherapists. We get results.” (Otis, 2012). AMHCA recognized that the identification of a practitioner who has specialized experience is important to potential clients who want to know that their time and resources invested counseling will make a real difference in their lives. For this reason, AMHCA established the Diplomate and Clinical Mental Health Specialist (DCMHS) certification program (Otis, 2012). The Diplomate must demonstrate advanced clinical mental health counseling proficiency, beyond the level of full state licensing, which is substantiated through certification and experience (Otis, 2012).

AMHCA Diplomate Specialties

(Otis, 2012)

Child and Adolescent Counseling
Couples Counseling
Developmental Disability Counseling
Family Counseling
Geriatric Counseling
Substance Abuse & Co-Occurring Disorders
Trauma Counseling

Goal 4: Delineation of Scope of Practice of the Profession

The scope of practice for the field of Clinical Mental Health Counselors was begun in 1979 with the publication of this initial definition of professional mental health counseling: an interdisciplinary, multifaceted, holistic process of the (1) promotion of healthy life-styles, (2) identification of individual stressors and personal levels of functioning, and (3) preservation or restoration of mental health. (Seiler & Messina, 1979). In 1986 this definition was improved upon as follows:

“clinical mental health counseling is the provision of professional counseling services involving the application of principles of psychotherapy, human development, learning theory, group dynamics, and the etiology of mental illness and dysfunctional behavior to individuals, couples, families and groups, for the purpose of promoting optimal mental health, dealing with normal problems of living and treating psychopathology. The practice of clinical mental health counseling includes, but is not limited to, diagnosis and treatment of mental and emotional disorders, psycho-educational techniques aimed at the prevention of mental and emotional disorders, consultations to individuals, couples, families, groups, organizations and communities, and clinical research into more effective psychotherapeutic treatment modalities. (AMHCA, 2011)

Through their standards setting and defining who they are, AMHCA has also identified that their professional work cover a broad range of issues from dealing with problems of living, promoting optimal mental health functioning, prevention, intervention and treatment of mental health disorders. AMHCA has always held that Clinical Mental Health Counselors serve clients who are socially and diverse (e.g. age, gender, race/ethnicity, religion, socio-economic status, sexual orientation), across the lifespan (e.g. children, adolescents, young and middle age adults, Baby Boomers and older seniors) (AMHCA, 2011).

As the population in the USA continues to diversify, CMHCs need to examine their cultural sensitivity issues in their clinical practice and begin to facilitate the growth of multicultural Clinical Mental Health Counseling competencies needed in the USA pluralistic society (Smith, Constantine, Dune, Dinehart & Montoya, 2006). It is imperative that CMHC’s become increasingly competent in understanding multicultural issues andneeds and to work to adjust their approach to diagnosis and treatment to reflect competence in dealing with these issues and needs.

Another major change in the scope of practice is the changing direction of work within both public and private agencies and private practices. New models of counseling are emerging from the traditional individual counseling mode to other activities. These include, but are not limited to: consulting with police, fire and other first responders to help them deal and cope with the trauma they experience in their everyday work; working with schools and houses of worship to provide psycho-educational programming in the areas of stress reduction, resilience building, marital enrichment, healthy parenting strategies to enhance children’s self-esteem; working with collaborative divorce lawyers to assist couple to gain divorces which protect the mental health of both the children involved as well as of the adults, and a variety other community consultation efforts which are geared to enhancing the wellbeing of people in the workplace, schools and communities at large (Haverkamp, Robertson, Cairns & Bedi, 2011).

The Affordable Care Act (ACA) has encouraged a healthcare system transformation that includes integration of behavioral healthcare into primary care settings. It is not yet clear what role mental health practitioners will have in that evolving system. The American Counseling Association, as should the American Mental Health Counselors Association, should continue to advocate for CMHC’s to be included in both the Medicaid expansion programs and the state-based health insurance exchange plans as a federal component for all states. Critical issues affecting all MHC practitioners in the evolving healthcare system include access to program participation in Medicaid and health insurance exchange products, payment reform, new reimbursement structures, evolving practice models, acquisition of the skills necessary to practice in team-based primary care environments, and demonstration of the mental health professions value to the greater healthcare system (Nordal, 2012). Professional associations in mental health need to continue to work with legislative, legal, and regulatory issues to insure that the needs of clients and the professionals are heard and addressed through better incorporation of mental health services in all aspects of the service delivery systems encouraged by the ACA (O’Donnell, Williams, Eisenberg & Kilbourne, 2013).

Goal 5: Delineation of Professional Development for its Members

Professional development is a broadly defined construct that underlies professional’s education and training which is intrinsic to their professional functioning and their professionalism throughout their careers (Elman, Illfelder-Kaye & Robiner, 2005). In line with its commitment to professional development, AMHCA has consistently established and promoted it professional clinical standards beginning in 1979 with its first set of standards (AMHCA, 1979) which were revised in 1992, 1993 (AMHCA, 1993), 1999, 2003 and most recently in 2011 (AMHCA, 2011).

Since 1987, when AMHCA introduced the first significant 60 hour specialty certification standards accepted by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) (Seiler, Brooks and Beck, 1987), AMHCA has succeeded in raising the bar for the standard of practice for Clinical Mental Health Counselors. More recently, AMHCA has accepted the 2009 CACREP Standards which specify that trainees in CACREP accredited Clinical Mental Health Counseling must complete no less than 60 graduate semester hours beginning January 2016. These accredited CMHC programs must meet the following Core requirements: 1) Professional Orientation and Ethical Practice; 2) Social and Cultural Diversity; 3) Human Growth and Development across the lifespan; 4) Career Development; 5) Helping Relationships; 6) Group Work; 7) Assessment; 8) Research and Program Evaluation. In addition to the Core requiremtns CMHC accredited CACREP programs must meet the following CMHC requirements: 1) Ethical, Legal and Practice Foundations of Clinical Mental Health Counseling; 2) Prevention and Clinical Intervention; 3) Clinical Assessment; 4) Diagnosis and Treatment of Mental Disorders; 5) Diversity and Advocacy in Clinical Mental Health Counseling; 6) Clinical Mental Health Counseling Research and Outcome Evaluation (AMHCA, 2011).

In 2011, AMHCA specifically recommended standards beyond the 2009 CACREP Standards for Clinical Mental Health Counseling Training Programs by recommending the addition of focus on: 1) Biological Bases of Behavior (including psychopathology and psychopharmacology); 2) Truama and 3) Co-Occurrring Disorders (mental disorders and substance abuse).

Pearson (2004) identified qualities in students in CMHC programs which makes them ideal candidates to become CMHC professionals. It is imperative that the CMHC Professional Organizations as the national, state and local levels provide CMHC students that the following are important attributes to possess to be not only successful in CMHC supervision but in actual clinical practice:

Ideal Qualities Desired in CMHC Students

Psychological-mindedness and openness
Interest and desire
Motivation and initiative
Enthusiasm and eagerness
Dependability
Interpersonal curiosity
Empathy
willingness to risk
Intellectual openness
Habit of developing professional knowledge
minimal defensiveness
Introspection
Receptivity to feedback
Personal, theoretical, and clinical flexibility (Pearson, 2004).

It is imperative that as AMHCA promotes the professional development of its members it continue to promote its National Certification Credentials the CCMHC since for health care professionals such as CMHCs a nationally recognized credential is important because consumers care a great deal about the quality of services and yet have so little ability to judge quality themselves. For this reason national credentials like the CCMHC serve as necessary proxies for direct measurement of quality (Hall & Boucher, 2008).

A special consideration in professional development of CMHC students needs to be a way to connect the novice professional with the organizational and procedural logistics which exist in the real world outside of the university setting (Noordegraaf, 2011). Counselor Education Programs in Clinical Mental Health Counseling are aware of the need that in training new professional CMHC’s there is a need to prepare for providing quality services in real world organizational settings (Noordegraaf, 2011). It is for this reason that CACREP Standards for CMHC training require up to 1000 hours of supervised clinical counseling work in real world clinical settings to give the students an organizational perspective they cannot get by remaining in the four walls of a classroom. It is a known fact that real world mental health service delivery systems force neophyte professionals to become rank and file professionals, who have become more organizationally savvy (Noordegraaf, 2011).

Goal 6: Delineation of State and National Level Regulation and Credentialing

The American Mental Health Counselors Association has always posited the need for licensure at the state level and certification at the national level to accomplish two goals: 1) to protect clients from incompetent, unqualified, unskilled and unprincipled people who hold themselves out as mental health practitioners and 2) that well-trained and competent mental health practitioners need legal status given that these credentials are used by third party payors to identify whom they will reimburse for the clinical work with clients (Glosoff, Benshoff, Hosie & Maki, 1994; Smith, 2011).

In 2010, the American Psychological Association (APA) published its latest model for state licensure for psychologists a practice which they had started in 1955, 1967, 1987 and 2010 (APA, 2011). Their declaration of policy included this statement: “ The practice of psychology in (name of state) is hereby declared to affect the public health, safety, and welfare, and to be subject to regulation to protect the public from the practice of psychology by unqualified persons and from unprofessional conduct by persons licensed to practice psychology” (APA, 2011).

Unfortunately there has been a theme among some increasingly small numbers of counseling professionals which has not been in favor of licensing or certifying counselors to diagnose and treat people with mental health disorders. According to one model the reason for this disdain is that these forms of regulation raise distinctions and divisions between human being and professional, practitioner and client, personal/private and public, person/family and social systems, the clinic and society, and the clinical and the social ( Tudor, 2011). The belief goes that given the human emotional system operates personally, in the family, at work, and in social systems, it is important to have knowledge how this system operates which will result in identifying new and hopefully more effective ways of improving human relationships (Tudor, 2011). The state regulation through licensure which is mandate to be identified as a mental health profession in one’s professional field and the national certification of one as being a qualified and competent practitioners in one’s field, separates these practitioners from the very people (their clients) whom they are trying to assist and help. These licenses and certificates work against the emotional connection that people need to rebuild and reformulate their emotional balance, so the argument goes (Tudor, 2011). While these positions could be argued as theoretically plausible among academics the applicability to the real world ignores the realities of professional accountability and consumer protection in an increasing regulated and mediated fee for service exchange. As with everything the world of professional associations there are dissenters who fear and point out that the process of professionalization which comes from state regulation through licensing does not always offer the benefits and privileges which are typically expected by achieving this status. Instead such regulation can greatly restrict the profession by requiring additional standards which are not required by their national association for accreditation boards (Timmons, 2011). While there may be a perceived theoretical downside to professionalization of counseling service, the upside is that accreditation, certification and licensure goes a long way to insure a uniform level of quality and standards in those holding themselves out as Clinical Mental Health Counselors to the public.

A major reality coming from difuse understanding of the Title, role and function of clinical Mental Health Counselors in our country we now have 7 different titles across all of the states as you can see in the chart below:

Licensure of Clinical Mental Health Counselors by State and Title

LMHC	LCMHC	LMHP	LPCC	LPCMH	LCPC	LPC
Florida	New Hampshire	Nebraska	California	Delaware	Idaho	Alabama
Hawaii	Rhode Island		Kentucky	South Dakota	Illinois	Alaska
Indiana	Vermont		Minnesota	Tennessee	Kansas	Arizona
Massachusetts			New Mexico		Maine	Arkansas
New York			North Dakota		Maryland	Colorado
Washington			Ohio		Montana	Connecticut
					Nevada	District of Columbia
						Georgia
						Guam
						Louisiana
						Michigan
						Mississippi
						Missouri
						New Jersey
						North Carolina
						Oklahoma
						Oregon
						Pennsylvania
						Puerto Rico
						South Carolina
						Texas
						Utah
						Virginia
						West Virginia
						Wisconsin
						Wyoming

Abbreviations for Licensure Titles for Clinical Mental Health Counselors

LMHC: Licensed Mental Health Counselor (6)

LCMHC: Licensed Clinical Mental Health Counselor (3)

LMHP: Licensed Mental Health Practitioner (1)

LPCMH: Licensed Professional Clinical Mental Health Counselor (3)

LPC: Licensed Professional Counselor (26)

LPCC: Licensed Professional Clinical Counselor (6)

LCPC: Licensed Clinical Professional Counselor (7)

NOTE: This data is current as of February 15, 2020

Goal 7: Advocacy for the Public Good

Active participation in professional advocacy activities is essential for professions to have a viable future. Strong advocacy efforts are required to advance the interests of profession (Fox, 2008). For Clinical Mental Health Counseling to become a rock solid mental health/health profession it is imperative that CMHC’s support their professional association’s efforts to secure Federal Legislative recognition as core providers under Medicare and any other Federal Health programs. It is also important to confront and overcome business and regulatory constraints on practice, and providing sufficient services to meet the growing diversity of the general population (Fox, 2008). This has been a priority of AMHCA since its founding.

Research has shown that most scholarly writing in MHC has not really impacted good clinical practice within the profession and therefore may not do much for the public. We propose however, that the profession establish amongst its professoriate rewards for publishing publishing efficacy studies and work related to systems, standards and policy improvements in the field which will affect how our profession impacts the public.

Where should students get the impetus to get involved in their professional organizations? In 2013 the answer was given: “much of the work done by counselor educators determines whether students will engage in their profession and join professional organizations, become nationally certified, or take on the role of advocate for their profession” (Reiner, Dobmeier & Hernandex, 2013). It is imperative that those who train Clinical Mental Health Counselors need to be Clinical Mental Health Counselors and engage their students to become active while still students in their local (Local AMHCA affiliates to the state and national organization), state (State AMHCA Branches) and national (AMHCA) Clinical Mental Health Counseling Associations.

A distinctive professional theoretical characteristic of Clinical Mental Health Counseling is its promotion of prevention and wellness services by its professionals (Matthews & Skowron, 2004). This typically involves efforts on the individual client level and larger systems efforts. It is important to for CMHC’s to educate clients and the public that social stressors contribute to the incidence rate of mental illness. In promoting preventions strategies CMCHs function as “change agents” with respect to social disparities that create individual and social problems. Public advocacy efforts are preventive in nature and it is imperative that the AMHCA provide sufficient time, treasure and talent to such advocacy efforts which involve it professionals down at the local level.

Here are three strategies for the Clinical Mental Health Counselors profession to keep it relevant, vitalized and proactive identified by Knapp and Keller in 2001:

Work hard to lower or remove barriers to quality CMHCs services within the mental care health delivery system for clients
Work hard to insure CMHCs are better integrated within the overall health care system, as opposed to being narrowly defined as mental health professionals on the outside only to be referred to in extreme cases
Work hard not to limit CMHCs to work or providing services just inside of the mental health care delivery system but rather to expand their expertise into the broader community to be better recognized as advocates and proactive problems solvers who work to better human welfare in a variety of domains (Knap & Keller, 2001).

Other goals for advocacy proposed by Copeland in 2005, which CMHCs can adopt are: To raise the level of resources and services available for mental health to equal those for physical health; to have campaign to end the stigma against mental illness; and to promote the idea that mental health is what all human beings seek, a healthy mind in a healthy body in a healthy emotional and physical environment. And that “There is truly no health without mental health” (Copeland, 2005, p.17).

Challenges in implementing effective policies which insure good mental health coverage for all peoples were identified by a team of researchers (Jenkins, Baingana, Ahmad, MdDaid & Atun, 2011). These challenges included:

Challenges in Creating Effective Mental Health Policies (Jenkins et al, 2011)

A lack of core indicators leads to invisibility and marginalization of people affected by mental disorders
Mental illness is not perceived as amenable to quick solutions
Human resource planning
Integration of mental health into the social development sector
Avoiding a narrow focus on psychosocial issues
Access to mental health interventions

A major advocacy concern is to provide psychoeducation and prevention services to parents and those adults who work with children to identify when their children or adolescents are need of mental health counseling services. Ford (2007) reported that “most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child’s difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope” (Ford, 2008. p 900). As part of this effort is the need to provide families, schools and the community education so that “sexualization of girls” which can lead to various issue such as eating disorders, adolescent pregnancy, early stage experimentation with drugs and alcohol, and severe anxiety and depression in young girls and adolescent females (Hatch, 2011). Developing programs which address the reduction and prevention of childhood obesity is another concern which mental health professionals need to take up (Tuckson, 2013). This is important because currently obesity contributes to the death of more than 360,000 Americans a year, it is feared that the current generation of children will suffer from preventable chronic diseases and too many may have shorter life spans than their parents if childhood obesity is not aggressively addressed by the current and emerging generation of mental health professionals (Tuckson, 2013).

Goal 8: Develop and Support Leadership in the Association

In a study of the leadership in professional organizations Rank and Hutchinson (2000) identified the following elements as key ingredients for effective leaders in professional associations:

1. Being Proactive: acting in anticipation of future problems by motivating, organizing, providing direction, advocating, mobilizing, staying involved, energizing, mentoring, displaying courage, creativity, aggressiveness, being passionate, innovative, displaying strength and persistence.
2. Values and ethics: activating the values of the profession, demonstrating ethical behaviors and commitment to the profession, taking on responsibility to further the goals of the profession and being a role model of professionalism and altruism
3. Empowerment: instilling confidence, encouraging a sense of hope in attaining goals, collaborating, being sensitive to the issues at the state and national level impacting the profession and ability to influence others
4. Vision: willingness and ability to translate vision to specific goals and objectives and helping others achieve them; understanding and forecasting and pointing the way to future directions, ability to visualize goals with values and ethics
5. Communication: being a good spokesperson, visible representative, representing the profession to the public through written and verbal tools and interpreting the mission of the profession to the public (Rank & Hutchinson, 2000).

When students in counselor training programs were asked what advice they would give to Counselor Educators on how to develop leadership qualities in their students, they said: “create a culture of leadership, create/provide opportunities, and teach leadership” (Meany-Walen, Carnes-Holt, Barrio-Minton, Purswell & Pronchenko-Jain, 2013).

Research done on professional identity found that many of the respondents valued professional identity when it was based on a sense of belongingness and affiliation, such as through their being members in professional associations and attending professional meetings and conferences. On the other hand these same respondents were less active in activities such as leadership and advocacy (Calley & Haley, 2008). The researchers concluded that these professionals "talk the talk" and were less willing to "walk the walk" of professional organizational activity. (Calley & Haley, 2008). This non-participation from members of a profession in leadership may not only impact the development of future leaders (i.e., students) in the profession, but might also have impact on the profession's ability to gain increased recognition in a changing legislative climate. The researchers concluded that “Ultimately, this could have dramatic implications on the future of the profession” (Calley & Haley, 2008, p. 15). There is a need for professionals not only to join their professional associations but to step up and take leadership roles to advance the causes of their profession.

Mentoring has been defined as the "process whereby a more experienced individual provides counsel, guidance, and assistance to another person, serves an essential function in helping younger or newer employees to develop leadership skills and advance within the organization" (Johnston, 2013). Mentoring has been recognized as especially important for young professionals because it provides a needed transition between graduate education and the clinical work world (Reznak, 2012). The use of onsite practicum and intern supervisors within the practicum and internship site required in the CMHC CACREP standards provides this mentoring of clinical leadership in the CMHC field. Another form of leadership development for professionals in training is to put them in charge student focused organizations, led and administrated by students. One such group is Chi Sigma Iota (CSI) which has been recognized in developing advocacy, leadership, and professional identity in student and its professional members (Luke & Goodrich, 2010).

A Boot Camp for Leaders is an approach which can be utilized stressing two major topics: 1) Leadership: Characteristics of high-performing associations; emphasizing professional engagement, mentoring and leadership; personal communication and thinking styles needed by effective leaders; leadership success stories and examples of professionals as leaders in challenging environments and 2) Professional Practice: Examples and stories of exemplary practices in the field; improving professional practice through improved self-awareness; promoting effective team and coalition building and use of experienced professionals as mentors for entry level professionals (Shekleton, Preston & Good, 2010).

It is important that CMHC students and new CMHCs recognize that be a member of AMHCA at the national, state and local level brings increased professionalism, autonomy, and self-regulation along with additional benefits of social interactions and peer support (Guerrieri, 2010). Of course in this new technological era, it is important for the AMHCA organizations to promote their social media outlets on Facebook, Twitter, YouTube etc (Spector, 2010).

Finally, it is hoped by its efforts at developing leadership among the ranks of clinical mental health counselors, new leaders will step up to join this list of Presidents of AMHCA since its inception:

Presidents of the American Mental Health Counselors Association

1977-1978 Nancy Spisso
1978-1979 James J. Messina
1979-1980 Steven P. Lindenberg
1980-1981 Joyce M. Breasure
1981-1982 Gary Seiler
1982-1983 William J. Weikel
1983-1984 Edward Beck
1984-1985 Richard Wilmarth
1985-1986 Rory Madden
1986-1987 David K. Brooks, Jr.
1987-1988 Nancy McCormick
1988-1989 Howard B. Smith
1989-1990 Larry Hill
1990-1991 Janet M. Herman
1991-1992 William Krieger
1992-1993 Gail Robinson
1993-1994 Roberta Driscoll Marowitz
1994-1995 John Nestor
1995-1996 Glenda Isenhour
1996-1997 Nancy Benz
1997-1998 Warren Throckmorton
1998-1999 Robert Bakko
1999-2000 Marion Turowski
2000-2001 Glenna Wentworth
2001-2002 Midge Williams
2002-2003 Bill Wheeler
2003-2004 Gail Adams
2004-2005 Jim Blundo
2005-2006 Carol Staben-Burroughs
2006-2007 Gail Mears
2007-2008 Gary Gintner
2008-2009 Victoria A. Sardi
2009-2010 Linda Barclay
2010-2011 Tom J. Ferro
2011-2012 Gray Otis
2012-2013 Karen Langer
2013-2014 Judith Bertenthal-Smith
2014-2015 Stephen Giunta
2015-2016 Keith Mobley
2016-2017 Suzanne Walker
2017-2018 Joseph Weeks
2018-2019 Howard "Al" Goodman
2019-2020 Eric Beeson
2020-2021 Angele Moss-Baker
2021-2022 Beverly Smith
2022-2023 Fredrick Dombrowski

Goal 9: Addressing Mental Health Trends

A good barometer of the trends in the mental health field addressed by AMHCA are the special issues or editions published by AMHCA’s Journal of Mental Health Counselor (Crockett, Byrd and Erford, 2012).

Special Issues or Sections of JMHC since 1994

Couple and Family Therapy: Constructivist/Ecosystem View (January 1994)
Disasters and Crisis: A Mental Health Counseling Perspective (July 1995)
Counseling Racially Diverse Clients (July 2001)
Multicultural Counseling Competencies (January 2004)
Perspective on Counseling the Bereaved (April 2004)
Unique Issues in Counseling the Bereaved (July 2004)
Master and Expertise in Counseling (January 2005)
Counseling Around the World (April 2005)
Counseling Outside of the United States: Looking in and Reaching out (July 2005)
Helping Military Personnel and Recent Veterans Manage Stress Reactions (April 2009)
Forgiveness in Therapy (January 2010)
Nonsuicidal Self-injury (October 2010)
Grief, Loss and Bereavement (January 2011)
Contemporary Issues in Private Practice: Spotlight on the Self-Employed Mental Health Counselors (July 2013)

Another measure of the trends in the mental health field which AMHCA has attempted to show a spotlight on are articles which appeared in the JMHC on: 1) state licensing movement; 2) changes related to managed care; 3) Psychopharmacology; 4) Clinical diagnosing; and 5) Use of technology in mental health services (Crockett, Byrd and Erford, 2012). Using the 2012 survey of the Journal of Mental Health Counseling the following breakdown of topical areas gives an overview to the Trending in the CMHC field since 1994:

JMHC articles focus from 1994-2012

(Crockett, Byrd and Erford, 2012).

38.3% of on practice,

10.7% on theory

37.3% on research

13.7% on professional exchanges

21.6% focused on techniques and theories of mental health counseling

16.9% on symptoms and disorders

13.3% on professional issues

11.4% on multicultural issues in mental health counseling.

Well ahead of the realities emerging from the Affordable Care Act (2010), in 2004 an article in the AMHCA journal called CMHCs attention to the emerging trend of Integrated/ Behavioral Medical Services which involved CMHCs in close collaborative work with primary care physicians. The purpose of the article was to propose strategies for CMHCs becoming involved in integrated care practices (Aitken & Curtis, 2004).

AMHCA has provided CMHCs recommendations on how to assess if a clients should be placed into psychiatric hospital for intensive care (Schwarts, Zarski & Hilscher, 2004). They identified suicidality and inability to care for one’s self significantly predicted if a CMHC would recommend inpatient admission for their clients.

“Addressing clients’ needs is essential to what we are as a profession” (Meyer, Sweeney & White, 2002, 394). Meyers et al argued, to productively engage in interprofessional collaboration, counselors must be able to articulate their professional identity and illustrate an understanding of the shared and unique assets between counseling and related helping professions (e.g. Social Work and Psychology) (2002).

In 2005, AMHCA Led the way in opening a national dialogue on Co-Occurring Disorders under the leadership of its then President Jim Blundo (2004-2005):

From Alcoholism & Drug Abuse Weekly April 11, 2005

Two conferences, one in Orlando, FL. Jan. 27-28, 2005 and one in Portland, OR. March 17-18, 2005 brought together members of NAADAC, the Association for Addiction Professionals and the American Mental Health Counselors Association (AMHCA) under the same roof for the first time to discuss co-occurring mental and substance use disorders.

In 2005, According to SAMHSA, 50 to 75 percent of patients in substance abuse treatment had co-occurring mental illness, and 20-50 percent of those in mental health treatment had co-occurring substance abuse as well.

Jim Blundo was quoted as saying: “We need more of these workshops, the meetings bring us together in a non-threatening way and allow us to have a conversation.” In answer to the question: What do addiction counselors and mental health counselors have in common? “Compassion,” responded Blundo, who was in a private practice in Troy, Michigan at the time. At the conference all agreet that Blundo’s point is a pretty strong base to work from. However, the differences-in theories and beliefs and languages-are formidable. For example, addiction counselors lack the clinical understanding of underlying mental health issues that lead to the substance abuse, and Blundo said: “Addiction counselors focus on getting the person dry or clean or drug-free. Some mental health counselors look at it the same way. But others look at it a different way-that there are underlying causes of the substance abuse that need to be dealt with. You can get somebody clean, but you have to treat the whole person.”

Blundo went on to say that mental health counselors need to learn more about substance abuse. “Mental health counselors haven’t been trained in addiction treatment, they have very little course work on it, and there is nothing standardized for them on it.” Ideally, Blundo thinks one person should provide both the mental health and substance abuse treatment for a patient-this is what, in fact, he does. “I work with both kinds of patients, and that would be the best of both worlds.” The problem, he concedes, is that there aren’t enough mental health counselors to treat all the patients with co-occurring substance abuse problems-or for that matter enough addiction counselors to treat all the patients with co-occurring mental disorders.

The key to next steps is coalition-building. “I would hate to see an organization just for counselors who treat co-occurring disorders, because then we’d have a dissolution of counselors instead of a coming together,” said Blundo. “What we need to do is coalition building. When everybodygets done fighting over turf, we’re all trying to help people who are in need of our services.”

As a result of this effort on AMHCA’s part in 2005, the AMHCA Standards of 2011 included comorbidity of substance abuse and mental disorders (AMHCA, 2011).

Three critical issues in 2008, were the need to have universal licensure for counselors in all 50 states, the need for widespread recognition by third party payers of mental health services by counselors, and national recognition for mental health parity which were tied to the profession of counseling gaining equal recognition as a mental health discipline. However, continued success in this area may be dependent upon the counseling profession's ability to clearly articulate the factors that comprise the professional identity of its members (Calley & Hawley. 2008).

Respondents who were all Counselor Educators in a recent study conducted in 2013 indicated that counselors, the American Counseling Association, and other counseling organizations are responsible for advocacy of the counseling profession. Collaboration among counselors for the development of a single coherent message is necessary for advocacy efforts aimed at congressional Medicare leaders, managed care organizations, state licensing boards, and allied professions (Reiner, Dobmeier & Hernandex, 2013). This study also found that professional counselors had the most responsibility for achieving license portability and recognition for reimbursable services under insurance carriers and Medicare (Reiner, Dobmeier & Hernandex, 2013).

Unfortunately this study did not involve counselors in the trenches of mental health services who are most impacted by Medicare, manage care organizations and licensing boards and there is an ever increasing need for Clinical Mental Health Counselors and Students in Clinical Mental Health Counseling to become active in AMHCA at the national and state branch level to clean up the issue of professional identity so that the needs of the Clinical Mental Health Counselors who are the “worker bees” in Mental Health Settings have and maintain parity with their professional colleagues in psychology, social work, psychiatry and psychiatric nursing.

A new trend which has involved a number of mental health professionals is the field of online mental health treatment via text or video (Kolmes, 2012). There are legitimate reasons for for these professionals to use these technologies including: 1) Enhancing services for rural populations; 2) Improving and increasing access to care; 3) Ability to provide treatments to special populations who may not be able to find clinicians with expertise to help with their issues in their own communities (Kolmes, 2012).

Relevant “bread and butter” issues for Clinical Mental Health Counselors which their AMHCA and their state branches are currently addressing are 1) Recognition among mental health service providers as an equal partner; 2) Inclusion in third party insurance panels; 3) Gaining Medicare reimbursement at the federal level; 4) Sustained recognition as competent mental health providers under Tricare and in the VA’s Mental Health Services and 4) Improving the portability of counselor licensure from state to state.

Issues for AMHCA and ACA Consideration

One point to consider: What gives impetus to students getting involved with their professional counseling associations is more of the job access than anything else. Students will pay dues if they know they can go to a placement center online and get a job through the association. APA and NASW have mastered this. ACA and AMHCA have not. These associations are not delivering jobs, just standards and theory. They need to address this need in the future.

The success of the APA, AMA, ABA, NASW has been because they are perceived as guild organizations. There are standards to be members of the guild and that the guild advocates as a group from its educators through its practitioners. There is a need for ACA and AMHCA to develop the concept of working to achieve guild status to strengthen internally and externally. Unfortunately there has been a proliferation of separate divisions, associations and accrediting bodies which have contributed to confusion. Lawyers belong to ABA and ABA speaks for lawyers. Doctors belong to AMA and AMA speaks for doctors. However ACA, AMHCA, CACREP, ASCA, NBCC and other groups all claim to speak for counselors and it is a confusing message to the public, legislators, colleagues and insurance groups, as well as other professionals. There is a need for ACA and AMHCA along with CACREP and NBCC to advance a a guild identity, perhaps with specialties and allied identities. If this is not done in an expeditious manner there is a strong possibility that the identify of Clinical Mental Health Counselors will get lost and the profession will be weakened as a result of this loss of guilded professional identity.

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