1. © 2016. Cengage Learning. All rights reserved. Chapter 17 Clinical Mental Health Counseling 1

2. © 2016. Cengage Learning. All rights reserved.  How CACREP defines Clinical Mental Health Counseling  Content knowledge in 8 areas common to all CACREP programs (e.g., school, clinical mental health, college counseling, etc.)  Additional coursework in such things as psychopathology, psychopharmacology, treatment planning, addictions, marriage and family, and more.  2009 CACREP standards did away with the 48 hour community counseling program  CACREP requires 60 credits for Clinical Mental Health Counseling 2 What Is Clinical Mental Health Counseling?

3. © 2016. Cengage Learning. All rights reserved.  In most states, if you don’t go through a CACREP-accredited program you can still get licensed  Most states require that you have 60 credits in Clinical Mental Health Counseling (regardless of specialty area) to be eligible to become a Licensed Professional Counselor  There still isn’t easy transferability from one state to another as states often have similar, yet different requirements to be an LPC  See Box 17.1, p. 549: What a Long Strange Road Its Been 3 What Is Clinical Mental Health Counseling?

4. © 2016. Cengage Learning. All rights reserved.  Turn of 20 th century  Emotional problems seen as psychological in nature  Freud—1 st comprehensive theory  Sanitariums became more humane  Vocational guidance and counseling  1930s  Federal money for mental health treatment and research  Increasing humane mindset toward mental illness  1940s  New approach to counseling that encapsulated psychoanalysis, counseling, existentialism, and American take-charge philosophy 4 History of Clinical Mental Health Counseling

5. © 2016. Cengage Learning. All rights reserved.  1940s (Cont’d)  New approach was optimistic and short-term compared to psychoanalysis  Around WWII, assessment techniques increasingly used  Recovery rates of emotional illness from the war were high  NIMH created  1950s  Mental Health Study Act of 1955  Expansion and acceptance of mental health services  Widespread use of psychotropic medication 5 History of Clinical Mental Health Counseling

6. © 2016. Cengage Learning. All rights reserved.  1960s  Upheaval in American Society  More social programs: Johnson’s “Great Society”  1963: Community Mental Health Centers Act  1960s and 1970s  Expansion of mental health centers and funded substance abuse treatment  1975: Donaldson vs. O’Connor  Rehabilitation Act of 1973  President Carter (and Rosalind): Focused on mental health  Establishment of AMHCA 6 History of Clinical Mental Health Counseling

7. © 2016. Cengage Learning. All rights reserved.  1980s to 1990s  Reagan’s Block Grants limited some services  Expansion and diversification of field  More diversification of settings  Most Recently  Advocacy of ACA, AMHCA, and NBCC to ensure clinical mental health counselors are included as providers  Gradual acceptance of diagnosis and psychopharmacology (see Table 17.1, p. 553) 7 History of Clinical Mental Health Counseling

8. © 2016. Cengage Learning. All rights reserved.  Most Recently (cont’d)  More credentials (e.g., 50 states have licensing)  Licensing is most important step toward counselors obtaining third-party reimbursement  Increased inclusion of counselors receiving third-party reimbursement  Patient Protection and Affordable Care Act (2010) expands mental health benefits of state insurance exchanges 8 History of Clinical Mental Health Counseling

9. © 2016. Cengage Learning. All rights reserved. Roles and Functions of the Clinical Mental Health Counselor Most Common Roles  Case manager  Appraiser of client needs  Counselor  Consultant  Crisis responder  Supervisor/supervisee  Accountability evaluator  Other? Other, Less Common Roles  Outreach worker  Broker/Networker  Advocate  Evaluator  Teacher/educator  Community planner  Administrator  Clinical assistant 9

10. © 2016. Cengage Learning. All rights reserved.  Another classification of roles and function:  Primary, Secondary, and Tertiary Prevention  Primary: Prevention and wellness  Secondary: Control of non-severe emotional problems  Tertiary: Control of serious mental health problems  See Figure 17.1, p. 554 10 Roles and Functions of the Clinical Mental Health Counselor

11. © 2016. Cengage Learning. All rights reserved.  Due to the number of different types of settings, it is difficult to talk about a theoretical focus.  However, Hershenson et al., (2003) offer 7 principles that govern the ways counselors deliver services at all agencies: 1.Respect the client. 2.Provide a facilitative environment that fosters client progress. 3.Help clients actively define goals in order to promote growth and development. 4.Empower clients and help them understand that counseling is an educational process involving client learning. 5.Focus on client strengths, not weaknesses. 6.Focus on both the person and the context (environment). 7.Use techniques shown to be valid through prior research. 11 Theory and Process of Clinical Mental Health Counseling

12. © 2016. Cengage Learning. All rights reserved.  Career and Employment Agencies  Associations: AMHCA; NCDA; NECA  Community Mental Health Centers  Association AMHCA  Correctional Facilities  Associations: AMHCA; IAAOC  Family Service Agencies  Associations: AMHCA; IAMFC; AAMFT  Gerontological Settings  Associations: AMHCA; AADA  See Box 17.2, p. 558 12 Settings Where You Find Clinical Mental Health Counselors

13. © 2016. Cengage Learning. All rights reserved.  HMOs, PPOs, and EAPs  Association: AMHCA  Military and Government  Association: AMHCA; ACEG  See Box 17.3, p. 560  Pastoral, Religious, and Spiritual Agencies  Association: AMHCA, ASERVIC, AAPC  See Box 17.4, p. 561  Private Practice Settings  Association: AMHCA  See Box 17.5, p. 563 13 Settings Where You Find Clinical Mental Health Counselors

14. © 2016. Cengage Learning. All rights reserved.  Rehabilitation Agencies  Associations: ARCA; NRCA  Residential Treatment Centers  Associations: AMHCA; ARCA, NRCA  See Box 17.6, p. 565  Substance Abuse Settings  Associations: AMHCA, IAAOC  Youth Service Agencies  Associations: AMHCA; ASCA  Other Settings? 14 Settings Where You Find Clinical Mental Health Counselors

15. © 2016. Cengage Learning. All rights reserved.  Clinical mental health counselors need to be aware of following: 1.Clients from non-dominant groups are under­represented at mental health centers 2.Clients from non-dominant groups are frequently misunderstood, misdiagnosed, find therapy not helpful, attend therapy at lower rates, and are more likely to terminate therapy 3.Clients from cultural backgrounds different from their counselor’s may experience counseling more negatively than others 4.Most counseling theories are Western-based and might be dissonant with some minority cultures’ values and attitudes 5.Some clinical mental health counselors may not have the sensitivity or training necessary to work with minority clients 6.Some mental health counselors have an ethnocentric worldview 15 Multicultural/Social Justice Focus

16. © 2016. Cengage Learning. All rights reserved.  Assessment of Clients: Testing and DSM-5  Be careful about bias in tests  Remember, that to some degree, diagnoses are culturally predisposed  Consider “culture-bound” diagnoses  DSM-5 offers Cultural Formulation Interview (CFI) and defines some cross-cultural symptoms; more cultural sensitivity  Limited Number of Counselors from Diverse Cultures  Agencies need to actively hire more minority counselors  Counselor Ed programs need to actively recruit more students of color 16 Multicultural/Social Justice Focus

17. © 2016. Cengage Learning. All rights reserved.  Ethical Issues  Ethical Complaints and Ethical Concerns  Ethical complaints made against LPCs (Neukrug, et al., 2001):  24%: inappropriate dual relationship  17%: incompetence in the facilitation of a counseling relationship  8%: practicing without a license or other misrepresentation  7%: having a sexual relationship with a client  5%: breach of confidentiality  4%: inappropriate fee assessment  1%: failure to inform clients about goals, techniques, rules, and limitations of the counseling relationship  1%: failure to report abuse  33%: Other 17 Ethical, Professional, and Legal Issues

18. © 2016. Cengage Learning. All rights reserved.  Ethical Issues  Perceptions of what is and is not ethical (see Table 3.2, p. 72)  Counselors have little agreement about some situations  Professional Issues  AMHCA  Addresses needs of wide spectrum of agency/mental counselors  Purpose: To enhance the profession of mental health counseling through licensing, advocacy, education and professional development  Provides a wide range of member benefits  Quasi-independent from ACA 18 Ethical, Professional, and Legal Issues

19. © 2016. Cengage Learning. All rights reserved.  Professional Issues  Credentialing  Certified Clinical Mental Health Counselor (CCMHC)  Master Addictions Counselor (MAC)  Nationally Certified Counselor (NCC)  Licensed Professional Counselor (LPC)  Outlook and Salary  Salaries can vary due to setting or region in which you live  Median Salary: $41,500 (according to Occupational Outlook Handbook) 19 Ethical, Professional, and Legal Issues

20. © 2016. Cengage Learning. All rights reserved.  Select Legal Issues  HIPAA  Provide information to patients about their privacy rights and how that information can be used.  Adopt clear privacy procedures for their practices.  Train employees so that they understand the privacy procedures.  Designate an individual to be responsible for seeing that privacy procedures are adopted and followed.  Secure patient records. 20 Ethical, Professional and Legal Issues

21. © 2016. Cengage Learning. All rights reserved.  Legal Issues  Confidentiality of Records Assured by:  HIPAA  FERPA (Buckley Amendment)  Freedom of Information Act of 1974  Client’s rights to their records  They have rights to view their records (except process notes)  Parents usually have rights to view their children’s records 21 Ethical, Professional, and Legal Issues

22. © 2016. Cengage Learning. All rights reserved.  Legal Issues  Confidentiality and Privileged Communication  Licensed practitioners have privileged communication  The privilege is held by the client  Confinement Against One’s Will  As result of Donaldson v. O’Connor, one can no longer be held against his or her will unless he or she is at danger of harming self or other  Individuals can generally be held for short amount of time, pending court hearing 22 Ethical, Professional, and Legal Issues

23. © 2016. Cengage Learning. All rights reserved.  Growing, Changing, Accepting  The ever-increasing acceptance of diagnostic tools such as DSM-5  The dramatic shifts in the health care delivery system  The increase in the kinds of counseling services offered  The ever-increasing knowledge of multicultural issues and their effects on client treatment  The development of new ways of treating individuals with various emotional problems 23 The Clinical Mental Health Counselor in Process