Mental Health Counseling: Identity and Distinctiveness.
by Pistole, M. Carole
The human service provider field is comprised of a complex and bewildering
array of overlapping and related, but separate professions that include
mental health counseling, psychology, social work, marriage and family
counseling, professional counseling, and psychiatry. Because each provider
profession has essentially the same goals and accomplishes these by performing
similar activities, human service delivery professions may seem very alike
from the outside, which means that it can be very confusing to understand
a profession's distinct identity. It is not particularly surprising that
the nuances that distinguish these professions seem amorphous, unclear,
and perhaps somewhat irrelevant to the public.
Graduate programs that train professionals for entry into a particular
field spend 2 to 4 years purposefully socializing their students and providing
them with a foundation in the profession's history, its knowledge and techniques,
and its relevant values, attitudes, and identity themes. Moreover, persons
seeking mental health services can usually be helped by virtually any of
the service providers, because of the interdisciplinary nature of the knowledge
and theory of intervention related to personality organization. Nonetheless,
it is worthwhile for the professions to articulate their distinctions.
This clarification is a vehicle to gain recognition and to vie for their
legitimate position in the health care market place, and it also constitutes
responsible behavior that is consistent with being accountable to the public's
sanctioning of the professional work.
In terms of clarifying uniqueness, the borders of the human service
delivery fields can be distinguished based on "professional identification,
... practitioner's entry level graduate degree ..., basic academic discipline,
conceptualization of mental health problems, and approach to treatment"
(Hersehenson & Power, 1987, p. 3). By weaving these elements into a
discussion of the history of the profession, the identity which organizes
its stability, and the distinctive characteristics which are included and
excluded within its identity, this paper seeks to convey to readers the
uniqueness of one of the youngest service provider professions, Mental
Health Counseling (MHC) (cf. Pistole & Roberts, in press).
MENTAL HEALTH COUNSELING - HISTORICAL TRADITION
MHC has a brief but bold past. In the social-historical-economic context
following World War II, non-medical, behavioral and cognitive approaches
to psychotherapy flourished, with some of this growth being stimulated
by the Community Mental Health Centers Act of 1963. This act, which "established
funding for the development of community-based mental health care programs
with interdisciplinary teams" (Weikel & Palmo, 1989, p. 8), contributed
to increasing the number of master's-level practitioners. Many of these
practitioners were trained in colleges of education and secured employment
under a variety of professional and paraprofessional titles in community
settings (e.g., hospitals, private practice, community mental health centers)
(Beck, 1999; Weikel & Stickle, 1989). Although effective as professionals,
because they were not trained in the disciplines of social work, psychology,
or medicine (psychiatry), these practitioners were without a professional
organizational home and were unqualified for the traditional credentials
or licensure; that is, they were disenfranchised and rendered professionally
invisible. This new group of professionals, who had emerged within the
health care field, began a grass roots movement and in July, 1978 formed
the American Mental Health Counselors Association (AMHCA) to provide themselves
with a professional organization and identity. From its inception, AMHCA's
purpose was to pursue recognition, develop accountability standards, and
acquire professional status for these practice-oriented master's professionals
who were already entrenched in the marketplace (Beck, 1999). In turn, the
pioneering founders of the profession, drawn to this newly established
identity of mental health counselor because they "believed in the power
of counseling" (Palmo, 1999, p. 217), began the political process of differentiating
their activities, roles, and identity from other service provider professions
so that the uniqueness of their profession was revealed to both themselves
MENTAL HEALTH COUNSELING - IDENTITY
In terms of a defining identity, MHC can be understood as "an aggregate
of the specific educational, scientific, and professional contributions
of the disciplines of education, psychology, and counseling" (Spruill &
Fong, 1990, pp. 20-21). From early on, mental health counselors have defined
their work as "an interdisciplinary multifaceted, holistic process of (1)
the 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, p. 6).
When discussing identity themes, MHC has identified itself as a profession
in which the person is conceptualized both developmentally and holistically
with attention to contextual influences on persons' lives (Hershenson &
Power, 1987). This approach involves both systemic and individual perspectives.
On the one hand, from the systems perspective, clients are embedded within
and influenced by their family, societal, historical, cultural, and socioeconomic
context, which means that community resources and interdisciplinary approaches
can be useful in treatment. Simultaneously, the individual can be viewed
as being the gestalt of multiple domains - emotional, physical, social,
vocational, and spiritual - that coalesce and culminate in a more or less
healthy life style. As part of the health care industry, mental health
counselors focus on a wellness, holistic mental health philosophy, regardless
of whether the clients' issues are more reflective of developmental struggles
or more reflective of clinical pathology. That is, the profession endorses
a philosophy that is focused more on strengths and wellness, as springing
from the multiple synthesized domains of the person, and focused less on
curing some kind of mental illness.
This way of thinking about clients is also reflected in mental health
counselors' collaboration with other professionals. Traditionally, the
mental health counselor has worked in a community setting (e.g., a community
mental health center) and participated as a contributing member of a health
care team. In parallel to viewing clients as individuals within a complex
system, mental health counselors see themselves as a profession that functions
and contributes within a complex system of health care providers. Thus,
mental health counselors extend the contextual, holistic health model to
the broad professional environment, and also focus attention on understanding
other professional frameworks in order to improve their own effectiveness
in interdisciplinary teams. Similarly, consistent with a growth and developmental
philosophy, mental health counseling, as a profession, has been responsive
to market changes within the political and social zeitgeist of health care.
This flexibility is a necessary aspect of remaining vital and viable, that
is, healthy, as a provider in the health care industry. Thus, during its
development, MHC has demonstrated flexibility within stability: It has
retained its core identity elements of development, strength, and mental
health in a holistic interdisciplinary perspective, while integrating new
competencies that are consistent with today's managed care environment.
For instance, remedial intervention as well as the diagnosis and treatment
of psychopathology has been synthesized within the mental health counselor's
underlying philosophy of strengthening or restoring development and mental
health (versus curing mental illness or helping clients adapt to the functional
impairments which accompany mental illness).
MENTAL HEALTH COUNSELING - DISTINCTIVENESS
As a master's level, primarily practice-oriented profession, MHC has
distinguishing characteristics in terms of what it excludes and includes.
Most obviously, MHC professional training builds on the theory and research
of the behavioral sciences, but the education is not specific to the disciplines
of social work, psychology, or medicine. On the other hand, there are specified
standards for MHC training, with accreditation available from the Council
for Accreditation of Counseling and Related Educational Programs (CACREP),
if programs qualify by meeting the standards. Standards include 60 credit
hours with specified course work and supervised experience. However, these
standards, unlike doctoral education, do not include a requirement for
scholarly productivity, though some programs do provide students' the opportunity
to do a master's research thesis. Although a practice-oriented profession,
because of its interdisciplinary dimension and valuing of research productivity,
MHC can comfortably include people who stretch the practitioner boundary;
that is, the profession prizes the production and dissemination of scholarship,
as evidenced by the publication of research in the profession's Journal
of Mental Health Counseling. Nonetheless, the employment settings of most
mental health counselors support efficacious practice rather than necessitate
or reward scholarship.
In relation to included characteristics, MHC shares a border with professional
counseling in its conceptual and philosophical perspective that is more
educational, developmental, and preventive than clinical, remedial, and
medical (Seiler & Messina, 1979). As mental health counselors draw
on the interdisciplinary knowledge base of the behavioral sciences, they
implement a scientist-practitioner approach to delivery of services. They
are, by training, effective consumers of the research and theoretical literature
and continue their learning throughout their careers, because their foundation
for practice is the research and theory which is continually being developed
and refined. Moreover, mental health counselors' practice resembles the
process of science in terms of practice being based in skeptical, cautious,
and evidentially-based judgment. In fact, practice constitutes the implementation
of science, that is, reflects local and idiosyncratic research with each
client. The research with each client is represented as an integrated way
of critical thinking and a style of working from the scientific attitude
of inquiry, by using theory and systematic observation to build hypotheses,
collect data, interpret data, seek alternative explanations for the data,
and revise hypotheses. In terms of credentials, in most states, mental
health counselors obtain a license for practice. The title is often generic,
termed "professional counselor," though some states use the title "mental
health counselor." In addition, these professionals may hold a specialty
credential as a Certified Clinical Mental Health Counselor.
Mental health counseling, one of the youngest of the human service provider
professions, was formed by in-the-field professionals who were seeking
visibility and recognition during the late 1970's. Based in the knowledge
of the behavior sciences and trained to focus on strengths, development,
and the holistic, multifaceted aspects of on-going mental health, mental
health counselors use scientific processes to strengthen or restore clients'
mental health. Their framework for conceptualization integrates (a) the
person as a gestalt of various domains with (b) the person's position in
the family and socio-cultural matrix. This focus extends the resources
for intervention to include the environment and extends the pressures and
inhibitions on development to include macro-systemic characteristics as
well as family or personal dynamics. It is a misunderstanding to construe
"mental health counseling" as meaning "to help those who suffer with mental
illnesses to adapt to life more effectively." Rather, mental health counselors
are concerned with health and with the wide variety of circumstances, socially
and individually, that can impair or inhibit the functioning of a person's
life. Mental health counseling is designed to contribute to the vitality
and vigor and to the soundness in body, mind, spirit, and social connection
that sustains well-being, and so is considered, by our society, to be health.
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