Professionalization of the Field of Clinical Mental Health Counseling
Chapter 1:
An Overview of the History of the American Mental Health ounselors Association (AMHCA) and the Creation of the Clinical Mental Health Counseling Profession
By Jim Messina, Ph.D., CCMHC, NCC, DCMHS
Gray Otis, Ph.D., CMHC, NCC, CCMHC, DCMHS
& Ed Beck, ED.D, CCMHC, NCC, LPC
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Foreword*
Early Legacy of Counseling prior to the Establishment of AMHCA
Frank Parsons (1854-1908)
- Father of Vocational Guidance
- Founded the Boston Vocational Bureau and wrote “Choosing a Vocation” in 1908
- 1st chapter was entitled “The Importance of the Scientific Method”
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History of Counseling based on Parson’s work:
- 1908: Parsons writes book establishing the vocational guidance counseling process, employing the scientific method, and establishes Boston’s Vocational Bureau to implement counseling
- 1909: Boston commissions the first 117 counselors in the country
- 1910: 35 cities in the U.S. report having paid guidance counselors in their schools
- 1911: Harvard vocational guidance course is first such course established
- 1913: First counseling association, along with professional magazines, journal, etc. founded
- World War 1: Counselors administered Army Alpha Beta tests during World War I
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William M. Proctor, Charles G. Wrenn & Glidden R. Benefield
- The first use in professional literature of the term "counselor" to describe professionals who implemented the counseling process was published the 1931 Workbook in Vocations (Proctor, Wrenn & Benefield, 1931).
John M. Brewer
- Wrote “Education as Guidance” in 1932
- Argued that counselors must expand their focus beyond vocation and education and into addressing and treating mental problems by proposing that counselors could prevent or ameliorate mental illness by providing guidance on mental hygiene, relationships, citizenship, leisure and recreation, personal well-being, ethics, civil cooperation, and wholesome and cultural action (including the advancement of civil rights for racial minorities).
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“Until we greatly modify our school courses, which still stress physiology, and until we begin to teach children the elements of mental hygiene and simplified, wholesome habits of living, we can hardly expect adequate results…It seems clear that…guidance in developing a wholesome thought about one’s own person might go far to eradicate such difficulties and tendencies.”
(Brewer, 1932, p. 65)
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E.G. Williamson (1900-1979)
- Coined the term clinical counselor to reflect empirically based scientific method that sought to decrease nonproductive thinking and strengthen effective decision-making
- Believed that clinical counselors must test, diagnose, and then treat
- Believed non-verbal gestures on the part of the counselors were vital
- Believed counselors should give advice
- Saw clinical counseling as an art that used scientific tools
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“The clinical counselor…should be well grounded in the literature of personnel research and preferably carry on research in order to remain critical and informed of new developments in techniques. The diagnostic phase of clinical work, however, must go beyond statistics in its application to particular students. In this sense clinical work is an art and not a science. It is not, however, non- or antiscientific. It is a task in logic, an interpretation of a mass of seemingly inconsistent and irrelevant data in a search for a consistent pattern of meaning. It is also a task in conjuring up suggestions for the student's actions and in inducing students to become eager and willing to cooperate in trying out actions which appear to be promising for the prevention or correction of maladjustments.”
(Williamson, 1939, p. 22)
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History of Counseling since Williamson prior to formation of AMHCA in 1976
- World War II: Counselors served in psychiatric units to treat military servicemembers during and after World War II
- 1963: Community Mental Health Centers Act (1963) opened the door for counselors to become core clinicians working with chronic and persistent mental illness in community settings
References:
Brewer, J.M. (1932) Education as guidance. NY, NY: Macmillan
Williamson, E.G. (1939). How to counsel students. NY, NY: McGraw-Hill.
Parsons, F. (1909). Choosing a vocation. Boston: Houghton Mifflin
Proctor, W.M., Wrenn, C.G. & Benefield, G.R. (1931). Workbook in Vocations. Boston, Houghton Mifflin.
* Forward was written in 2019 with the generous research and help of Aaron Norton, President of FMHCA and Southern Regional Representive for AMHCA
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How the Clinical Mental Health Counseling Profession Began
As the forerunner to the current American Counseling Association (ACA), the American Personnel and Guidance Association (APGA) did not provide a division for counselors who worked exclusively in the mental health field. A letter was printed in a 1976 APGA Guidepost magazine which suggested that APGA needed a subdivision dedicated to counselors who worked in mental health centers, marriage and family counseling centers and other community agencies with mental health missions. Two counselors at the Escambia County Mental Health Center in Pensacola, Florida, read this letter and agreed to make this possibility a reality. These colleagues, Jim Messina and Nancy Spisso, contributed their individual assets to instigate this mission.
Messina had served as the American School Counselors Association (ASCA) National Negotiation Committee Chair from 1972-75 and already had a working relationship with Thelma Daly, the president of APGA at that time. Daly had served as the president of the ASCA while Messina chaired the committee. Messina also knew the executive director of the APGA, Chuck Lewis, through previous service with ASCA and felt comfortable working with these key figures to create the new division. Messina and Spisso contacted Daly who connected them to Lewis. Immediately, Lewis provided a list of the steps to take and then sent the required documentation by mail.
Spisso and Messina submitted a letter that was published in Guidepost which announced their intention to form a new division within APGA called The American Mental Health Counselor’s Association (AMHCA). The selection of this title promoted the idea that all counselors working in mental health settings should be subsumed under the term “mental health.” Spisso and Messina coined the term "Mental Health Counselor" at that time which still functions as the best nomenclature for counselors whose job descriptions differ from the demands of school, rehabilitation, vocational, college, counselor education or personnel counseling.
The founders of AMHCA entered the field of clinical behavioral medicine without any educational underpinning for this new professional identity. Messina and Spisso did not realize that by using the term "clinical mental health counselors" that the professional training would need to emerge from the colleges of education and take its place in the field of behavioral medicine. Current training programs based in education departments were not in a political position to support the concept that their graduates engaged in “clinical mental health work”.
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In the February 2016 Issue of the AMHCA Advocate Magazine This Article Appeared
Celebrating 40 Years of AMHCA By Asking: How Did It Come to Be?
By James J. Messina, Ph.D., CCMHC, NCC, DCMHS-T
Why Start an Association for Mental Health Counselors?
The need seemed obvious. The earlier incarnation of the American Counseling Association—the American Personnel and Guidance Association (APGA)—did not include a division for counselors who worked exclusively in the mental health field. The letter that sparked the creation of AMHCA appeared in the February 1976 APGA Guidepost Newsletter suggesting that APGA needed a division dedicated to counselors who worked in mental health centers, marriage and family counseling centers, and other community agencies and mental health settings. The day Nancy Spisso and I read that letter, we were counselors at the Escambia County Mental Health Center in Pensacola, Fla. We talked about it and agreed on the spot to make this possibility a reality. I had served as chair of the National Negotiation Committee of the American School Counselors Association (ASCA) from 1972–75 and already had a working relationship with Thelma Daley, the president of APGA at the time, and Chuck Lewis, APGA’s executive director. After our impetuous decision to create the division, Nancy and I contacted Daley and Lewis, who gave us a list of the steps to take. Before any dust could settle, Nancy and I formally applied for creation of a new division. The March 1976 Guidepost announced APGA’s intention to form a new division called the American Mental Health Counselors Association (AMHCA).
The Impetus for the Association’s Name The initial name of the AMHCA division promoted the idea that all counselors working in mental health settings should be subsumed under the term “mental health.” The rationale for the name was based on the name of the American School Counselor Association. It was our belief as founders of AMHCA that the name ought to make it clear that the new organization was to be the birthplace of a new profession in the counseling field—and that the profession was housed in work settings focused on mental health. Nancy and I coined the term “mental health counselor” at that time, and it still functions as the best nomenclature for counselors whose job descriptions differ from the demands of school, rehabilitation, vocational, college, and personnel counseling, as well as from those in counselor education.
Overcoming Hurdles
More than 500 respondents to the notice in the Guidepost requested formal development of AMHCA. Unfortunately, at its spring 1976 board meeting, APGA put a hold on developing new divisions for at least a full year. This moratorium spurred Nancy and me to file in Florida to establish AMHCA as a nonprofit corporation, and my wife, Connie, became our first administrator. When the moratorium was lifted in spring 1977, AMHCA’s board asked its 1,500 members whether to continue as a freestanding organization or become an APGA division. When voting closed Dec. 30, 1977, by the slimmest of majorities—51 percent—voting members chose to become an APGA division. A formal application was submitted to APGA, and APGA welcomed AMHCA as a division at its spring 1978 board meeting.
An Unresolved Training & Identity Dilemma
When we co-founded AMHCA, Nancy and I did not realize that we were simultaneously helping to develop a new profession in the field of clinical mental health—one without any educational underpinning for this new professional identity. Using the term “clinical mental health counselors” meant that professional training for this new field would have to emerge from colleges of education. The then-current counselor training programs based in education departments were not in a political position to support the concept that their graduates engage in “clinical mental health work.”
This obstacle has, over the last 40 years, hindered the professionalization of the field of mental health counseling. Finally, however, in 2009 CACREP approved accreditation for clinical mental health counselors with a 60-hour graduate program requirement. To date, more than 3 00 counselor education programs are now accredited under the CMHC standards. Counselor educators had resisted using the term “mental health counselors,” and indeed, during licensure efforts, even presidents of AMHCA who were also leaders in APGA, the American Association for Counseling and Development (AACD), and the American Counseling Association (ACA) supported the term “licensed professional counselors.” This explains why the field of mental health counseling has a bifurcated naming. For its 50 state licenses, 17 states use “licensed mental health counselor” and the rest use “licensed professional counselor.”
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AMHCA Foundational Pillars for the Clinical Mental Health Counseling Profession
To expand upon their attempt to create a new division within APGA, Messina and Spisso soon realized that the fledgling profession required a strong foundation to build on. AMHCA was tasked to build a solid professional foundation and so, formulated the Six Foundational Pillars for the Clinical Mental Health Counseling Profession. These foundational pillars comprise the following elements: The professional association, the code of ethics, the national certification process, licensure in each of the fifty states of the U.S., competency-based educational accreditation standards, and the promotion of research in the field of clinical mental health counseling.
Pillar 1: Professional Association: AMHCA became a division of ACA in 1978. In 1998, AMHCA opened an independent national office in Washington with its own executive director but is still known and recognized as a national division of ACA.
Pillar 2: Code of Ethics: The first AMHCA Code of Ethics was quickly formulated based upon the existing APGA (ACA) code. Since then, additional codes which affect mental health counselors were written and updated for the American Counseling Association, the National Academy of Clinical Mental Health Counselors and the National Board for Certified Counselors.
Pillar 3: Accreditation & Educational Standards: This element was an area of tension between APGA counselor educators and the young AMHCA leadership from the outset. Counselor educators fought efforts to establish accreditation standards for mental health counseling programs. In 1992 under the AMHCA presidency of Roberta Driscoll Marowitz, Messina agreed to spearhead the effort to identify a means to accredit mental health counselor training programs. He suggested a competency-based model called the Orlando Model which created the National Commission for Mental Health Counseling. In 1995, this commission published a monograph titled Mental Health Counseling in the 90’s (Altekruse & Sexton, 1995). This publication reported on national research comprised of fifteen hundred CCMHCs to identify the competencies needed to provide mental health counseling and the competencies needed in counselor education programs.
In 1995, the AMHCA Board of Directors chose to transfer their funding from the National Commission toward efforts to establish its freestanding office in Washington D.C. The effort to accredit Mental Health Counseling programs diminished until the new Mental Health Counseling Training Standards from CACREP were formed fourteen years later, in 2009. Today, only about one hundred CACREP programs are accredited for CMHC training. “Community Counseling” was the politically acceptable term that counselor educators adopted in 2001 which inspired 160 of these courses of study in counselor training programs. This development weakened the growth and recognition of the Mental Health Counseling profession and became a contentious issue in 2009 when CACREP eliminated the Community Counseling Standards and replaced them with Clinical Mental Health Counseling Standards. Finally, after thirty-six years, a unified accreditation standard for the training of Mental Health Counselors existed. New standards for CACREP are expected in 2016 and should not differ greatly from the 2009 version. There are now over 300 graduate programs accredited by CACREP in Clinical Mental Health Counseling
Pillar 4: Nationally Recognized Certification: As president of AMHCA (1978-1979) Jim Messina’s goals included the creation of the National Academy of Certified Clinical Mental Health Counselors (NACCMHC). The Academy devised a competency-based assessment model and gained recognition for the first national certification body which required work samples from candidates. The National Academy then allied with the National Board of Certified Counselors (NBCC) making the CCMHC one of a number of advanced certifications open to the 48,000 Nationally Certified Counselors (NCC). Today AMHCA is now promoting a new designation: the AMHCA Diplomate. The Diplomate and Clinical Mental Health Specialist (DCMHS) credentials are based on graduate training, licensure, work experience and advanced training. The attainment of the CCMHC will be one significant prerequisite for such designations.
Pillar 5: State-Recognized Licensure for Independent Practice: In 1980, after the NACCMHC was established, Messina wrote the legislative language for the first Licensed Mental Health Counselors in Florida. In 1981, this bill passed the state legislature and in 1983 over eighteen-hundred counselors become LMHCs. Today in Florida, over ten-thousand LMHCs are practicing along with over eleven-hundred MHC residents pursuing full licensure.
Only sixteen states currently feature the term “mental health” in the title of their professional counselors. To add to the identity confusion, thirty-four states use the term “licensed professional counselors” as the legal descriptor which weakens the Mental Health Counselor designation. The American Counseling Association (ACA, 2011) documents the existence of 120,000 Licensed Professional Counselors, 54,785 Licensed Marriage & Family Therapists, and 202,924 Licensed Social Workers in the United States. In conjunction with the American Association of State Counseling Boards (AASCB), the ACA has promoted an effort titled “20/20: A Vision for the Future of Counseling” which commenced in 2010. The purpose of the 20/20 vision is to establish a definition of counseling with unified standards for training, certification and licensure and to design a portability system of licensure which will benefit counselors and strengthen the counseling profession. The definition of counseling which 20/20 developed is: “Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals” (Kaplan, Tarvydas & Gladding, 2010).
Pillar 6: Research into the Effectiveness of Clinical Mental Health Counselors: The Journal of Mental Health Counseling was established in 1976 featuring Bill Weikel as the first editor. The first edition of the Journal appeared in 1979 after AMHCA was formally recognized as an official division of APGA and has been published regularly since that time.
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Unfortunately, no theoretical model of counseling has developed with roots in Mental Health Counseling over the last thirty years. In addition, no significant body of research exists to assess and document the effectiveness of Mental Health Counselors. This fact has weakened the impact of the Clincial Mental Health Counselors among the other mental health professions and is an issue which needs attention by the professional organizations advocating for Mental Health Counselors.
Since the early 2000’s, AMHCA has focused on working cooperatively with ACA and AAMFT to include CMHCs and MFTs in Medicare Reimbursement. Major legislative initiatives have resulted in Federal recognition of CMHCs for hiring with the Veteran's Administration and the Department of Defense as well as TRICARE reimbursement.
CMHCs now make up over one fifth of the available psychotherapists who are licensed in the United States (approximately 120,000 of the total number of 502,000 psychotherapists).
AMHCA has become the first association to recognize specialized qualifications with the advent of the Diplomate and Clinical Mental Health Specialist credential which was inaugurated in 2012. Criteria were developed to ascertain both advance practice certification as a diplomate as well as qualifications for eight areas of specialized practice. This goal was accomplished so that CMHCs could provide the public and interested agencies with a certification regarding the post-graduate training and expertise the clinicians had acquired. The areas of specialization include:
Specialist in Child and Adolescent Counseling
Specialist in Couples Counseling
Specialist in Developmental Disability Counseling
Specialist in Family Counseling
Specialist in Geriatric Counseling
Specialist in Substance Abuse and Co-occurring Disorders
Specialist in Trauma Counseling
Additional information can be obtained at the AMHCA website.
AMHCA continued to update the AMHCA Code of Ethics with the latest revision in 2010. The code of ethics was developed specifically to address issues specifically pertaining to the practice of clinical mental health counseling in an era of increasingly complex ethical concerns.
In 2011, AMHCA published the latest edition of Standards for the Practice of Clinical Mental Health Counseling. As early as 1979, the association recognized the need for practice standards which it first published in that year. The 2011 edition recognizes the need for CMHCs to become more proficient in mental health concerns such as the biological basis of behavior, specialized clinical assessment, trauma, and co-occurring disorders. It also addresses issues regarding the graduate training of counselors as well as faculty and supervisor qualifications. 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 was first adopted in 1979, which was written in the establishment of National Academy of Clinical Mental Health Counselors (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 (CACREP) to adopt these standards for its sixty graduate-hour Clinical Mental Health Counseling Accreditation Standards.
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References
ACA. (2010-2012). 20/20 A Vision for the Future of Counseling. ACA: Washington, DC
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 - An Orlando Model Monograph Series Monograph.
American Counseling Association. (2011). 2011 Statistics on Mental Health
Professions. Washington, DC.
AMHCA. (1993). Standards for the clinical practice of Mental
Health Counseling. In AMHCA leader handbook. Washington, D. C: AMHCA
AMHCA. (2011). Standards for the clinical practice of mental health counseling.
Washington, DC: AMHCA
AMHCA Certification Committee. (1979). The Board of Certified Counselors
procedures. American Mental Health Counselors Association Journal, 1, 23-28.
AMHCA/NACCMHC Blue Ribbon Task Force. (1980). Standards and procedures for
competency based mental health counselor training programs. Unpublished Text. Washington, DC: AMHCA
Council for the Accreditation of Counseling and Related Education Programs
(CACREP). (2009), CACREP 2009 Standards, Washington, DC. CACREP
Covin, T. M. (1994). Credentialing - an Orlando model project report. Unpublished
Text, Washington, D. C.AMHCA.
Kaplan, D., Tarvydas V.M. & Gladding, S.T. (2010). 20/20: A vision for the future of
counseling: The new consensus definition of counseling. Retrieved at: http://www.counseling.org/knowledge-center/20-20-a-vision-for-the-future-of-counseling
McCormick, N. J. & Messina, J. J. (Eds.). (1987). Professionalization - the next agenda
for the mental health counseling profession: The proceedings of the 1987 AMHCA think tank. Washington, DC:AMHCA
Messina, J. J., Breasure, J., Jacobson, S., Leymaster, R., Lindenberg, S. & Scelsa, J.
(1978). Blueprint for the advancement of the counseling profession. Unpublished text. Washington, DC: AMHCA
Messina, J. J. (1979). Why establish a certification system for professional
counselors? A rationale. American Mental Health Counselors Association Journal, 1, 9-22.
Messina, J. J. (1985). The National Academy of Certified Clinical Mental Health
Counselors: Creating a new professional identity. Journal of Counseling and Development, 63, 607-608.
Seiler, G. & Messina, J. J. (1979). Toward professional identity: The dimensions of
mental health counseling in perspective. American Mental Health Counselors Association Journal, 1, 3-8.
Seiler, G. Brooks, D. K. & Beck, E. S. (1990). Training standards of the American
Mental Health Counselors Association: History, rationale and implication. In G. Seiler (Ed.) The mental health counselor’s sourcebook (pp. 61-77), New York: Human Sciences Press, Inc.
Otis, G. (2012). How does the DCMHS benefit you and the profession? AMHCA
Advocate, 35(1), 3-4.
Weikel, W. J. (1985). American Mental Health Counselors Association. Personnel and
Guidance Journal, 63, 457-60.
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