Evolution of Mental Health Counseling

Abstract

The field of clinical mental health counseling in the United States has undergone many evolutions, starting with the first documented form during the late 1890s with the Hull House in Chicago, to the current trends that are still in their early developmental stages. With changes in society, treatment options, ethics and educational standards have to evolve as well. While the current generation may experience some of the same challenges as their relatives a century ago, a plethora of new approaches exist currently which help counselors to assist in providing more customizable treatment programs. With the formation of new therapeutic interventions, new guidelines are required, in order to support both the provider and client in achieving a positive and favorable outcome.

Early Years of Counseling

            Mental health counseling has quite a long history in other countries, as compared to the United States. There are references dating back to Paris in the 1700s, in which the definition of mental health care was expanded to include “liberty, equality, and fraternity” (Brooks and Weikel, 1986). Corporal punishment was condemned and individuals who were mentally ill regained their rights as individuals due to the change in definition.

The Hull House, modeled after a London settlement house (Harkavy and Puckett, 1994), offered residents activities and services, which the founder Jane Addams designed along four lines: social, educational, humanitarian and civic. Such offerings included college courses, art exhibits, kindergarten and legal services. The Hull House was also a gathering place for individuals to exchange ideas and organize labor union activities and social science research.

The changes in society can be seen reflected in the way the field of mental health counseling has worked to adapt to the needs of the individuals it serves. Just as the Hull House initially was designed to assist immigrant groups and local residents in achieving a foothold in their new surroundings, violent conflict also caused growth to occur within the field.

Evolution in the Workplace and Education

            The early counselors were primarily vocational or worked in the school system. However, both World War II and the Vietnam War caused an increased need for those in the mental health field to work in what we view as a more contemporary employment location as therapists and counselors within the Veterans Administration. This increased need during the 1960s brought about changes within the educational system for counselors, as they no longer found themselves confined to the previous designations, thus unprepared to work effectively in the mental health community (Smith and Robinson, 1995). While colleges and universities still employ a large percentage of counseling psychologists (Munley, Pate and Duncan, 2007), the Community Mental Health Centers Act of 1963 led to the dispersal of counselors into new employment opportunities.

            Such transitions required new educational requirements for the mental health counseling profession. The current uniform standards for mental health counselors address educational, experience, supervision, standards of practice, ethics, examinations, competency-based work sample and statutory regulations.

            The Council for Accreditation of Counseling and Related Educational Programs (CACREP), founded in 1981, is the primary accreditation source for the counseling profession. According to CACREP guidelines, the requirements to become a mental health counselor include 60 semester hours of education; 3,000 hours of clinical experience, with 100 hours of face-to-face supervision (Smith and Robinson, 1995). These requirements are in addition to the state regulations set forth by local governments.

            A uniformity of coursework has helped to solidify the profession and gain recognition as a worthy cause, especially when it comes to the insurance companies. In a study conducted in 1998, spending on mental health care declined over 54%, during the years 1988 to 1998, decreasing from $154 per person to only $69 (Reed, Stout, Levant, Murphy and Phelps, 2001). More recently, mental health care insurance coverage has undergone a transformation with new legislation, including the Mental Health Parity and Addiction Equity Act, which requires insurance plans to use the same process used for evaluating medical or surgical benefits when factoring coverage for behavioral health treatment (Busch, 2012).

Conclusion

            While the field of mental health counseling has evolved from the early days of community resource centers, there are still a lot of steps that need to occur in order to serve the individuals who could benefit most from behavioral health programs. Improvements in outreach programs, sliding scale programs for treatment and continuing research into therapeutic intervention methods can only help to further the accessibility to such programs.

           

*References available upon request