Clinical Mental Health Counseling in Community and Agency Settings

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For courses in Community/Agency Counseling.

A strong foundation for building counseling skills that addresses the latest CACREP standards.

Rapid changes in our world compel changes in the way mental health counselors must practice. Focusing on approaches that promote prevention, early intervention, wellness, and advocacy, Clinical Mental Health Counseling in Community and Agency Settings gives today’s counseling students a user-friendly yet scholarly approach to all aspects of their future profession.

The Council for the Accreditation of Counseling and Related Educational Programs (CACREP) now recognizes only Clinical Mental Health Counseling (CMHC) programs that have met the accreditation standards; therefore, the authors now focus exclusively on clinical mental health counseling to give students a strong base in this specialty area. Gladding and Newsome examine the history and professional foundations of counseling, legal and ethical issues, counseling with diverse populations, multiple roles and functions of clinical mental health counselors, and the many settings in which clinical mental health counselors practice.

Information presented in the chapters is supplemented with narratives supplied by mental health professionals employed across counseling settings, who share their views of the rewards and challenges associated with the services they provide. In addition, case studies in each chapter provide opportunities for students to grapple with challenging issues faced by clinical mental health counselors.

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Samuel T. Gladding is a professor in the Department of Counseling at Wake Forest University in Winston-Salem, North Carolina. He is a fellow in the American Counseling Association and its former president (2004—2005). He has also served as president of the Association for Counselor Education and Supervision (ACES), the Association for Specialists in Group Work (ASGW), the American Association of State Counseling Boards, and Chi Sigma Iota. He is the former editor of the Journal for Specialists in Group Work, a past member of the American Counseling Association Foundation, and a past member of the North Carolina Board of Licensed Professional Counselors.

Dr. Gladding has authored numerous professional publications, including 45 books. In 1999, he was cited as being in the top 1% of contributors to the flagship periodical of the American Counseling Association: the Journal of Counseling and Development. A National Certified Counselor (NCC), a Certified Clinical Mental Health Counselor (CCMHC), and a Licensed Professional Counselor (North Carolina), Dr. Gladding’s specialty in counseling is creativity. He is married to Claire Tillson Gladding and is the father of three adult sons. In his spare time, he enjoys swimming, writing poetry, listening to music, and reading humor and history.

Deborah W. Newsome is an associate professor in the Department of Counseling at Wake Forest University in Winston-Salem, North Carolina, where she serves as the clinical mental health program director. She served on the Executive Board of the Association for Assessment in Counseling and Education (AACE) for 6 years and is a member of several divisions of the American Counseling Association (ACA). She is a National Certified Counselor (NCC), a Licensed Professional Counselor (LPC), and a Licensed North Carolina School Counselor. She teaches courses in clinical mental health counseling, counseling skill development, assessment, and career development and counseling. She also supervises graduate students’ clinical experiences and volunteers at a local nonprofit counseling center.

Dr. Newsome has coauthored three books and over 25 book chapters and journal articles. In 2005, she received Wake Forest University’s Graduate Student Association Faculty Excellence Award. She and her husband, David Newsome, are the parents of two young adults–David, Jr., and Jennifer. Debbie is an avid runner and swimmer and enjoys playing the flute for various community organizations.

BRIEF TABLE OF CONTENTS

PART I. HISTORICAL AND PROFESSIONAL FOUNDATIONS OF CLINICAL MENTAL HEALTH COUNSELING

1.  History of and Professional Identity in Clinical Mental Health Counseling

2.  Ethical and Legal Aspects of Counseling 

3.  Clinical Mental Health Counseling in a Diverse Society

PART II.  ROLES AND FUNCTIONS OF CLINICAL MENTAL HEALTH COUNSELORS 

4.   The Counseling Process 

5.   Client Assessment and Diagnosis 

6.   Holistic Approaches to Clinical Mental Health Counseling 

7.   Consultation, Advocacy, and Evaluation

8.   Dealing with Crises, Disasters, and Suicide, while Managing Stress, and Avoiding Burnout 

III.  WORKING WITH SPECIFIC POPULATIONS

9.   Working with Groups 

10. Couples and Family Counseling 

11. Counseling Children and Adolescents

12. Counseling Adults  

IV.  CLINICAL MENTAL HEALTH COUNSELING: SETTINGS AND SERVICES 

13. College and Career Counseling

14. Community Agencies, Medical Settings, and Other Specialized Clinical Settings  

15. Employee Assistance Programs, Private Practice, Coaching and Managed Care 

Epilogue

Appendix - ACA Code of Ethics (2014)

References

Name Index

Subject Index

DETAILED TABLE OF CONTENTS

PART 1: Historical and Professional Foundations of Clinical Mental Health Counseling 

Chapter 1. History of and Professional Identity in Clinical Mental Health Counseling

Historical Roots of Clinical Mental Health Counseling 

A Chronological Overview of Professional Counseling 

Before 1900 

1900—1909 

1910s 

1920s 

1930s 

1940s 

1950s 

1960s 

1970s 

1980s 

1990s 

2000—2009 

2010-2016  

Professional Identity  

Defining Therapeutic Professionals

Nonprofessionals

General Human Services Workers

Professional Helpers 

Defining Counseling

Legal Recognition of Counseling as a Profession 

Professional Identification through Credentialing

Inspection

Registration,

Certification

Licensure

Identifying and Defining Therapeutic Professionals

Social Work

Psychiatry

Psychiatric Mental Health Nurses

Psychologists

Clinical Mental Health Counseling 

Clinical Mental Health Practice Settings and Services

Direct client services,

Indirect client services,

Direct community services

Indirect community services

Summary and Conclusion 

Chapter 2. Ethical and Legal Aspects of Counseling 

Definitions: Ethics, Morality, and Law

Ethics and Counseling 

Purpose of Ethical Codes

The ACA Code of Ethics 

Overview of Changes Made to the 2014 ACA Code of Ethics 

NBCC Code of Ethics 

Limitations of Ethical Codes 

Making Ethical Decisions

Other Guidelines for Acting Ethically

Unethical Behavior

The Law and Counseling 

Criminal, Civil, and Administrative Law 

Malpractice 

Other Reasons for Court Appearances 

Common Ethical and Legal Concerns 

Privacy, Confidentiality, and Privileged Communication 

Informed Consent 

Professional Boundaries and Roles with Clients 

Professional Competence 

End-of-Life Decisions 

The Use of Technology 

Using Technology-Assisted Counseling Responsibly 

Summary and Conclusion 

Chapter 3. Clinical Mental Health Counseling in a Diverse Society 

Culture and Ethnicity 

Defining Culture and Multicultural Counseling 

Challenges and Issues in Multicultural Counseling 

Developing Multicultural Counseling Competencies 

Becoming Ethnically Responsive Counselors: Integrating Awareness, Knowledge, and Skills 

Sexual Orientation and Gender Identity 

Definitions and Terminology 

Homophobia and Heterosexism 

Sexual Identity Development and Coming Out

Other Counseling Issues and Implications

Working with Transgender Clients 

Differing Abilities 

Definitions and Terminology 

Factors Associated with Increased Rates of Disability 

Attitudes and Myths about Disabilities 

Federal Regulation Related to Disability 

Counseling Goals and Interventions 

Training, Roles, and Functions of Rehabilitation Counselors 

Counseling Issues and Implications 

Socioeconomic Status and Social Class 

Definitions and Terminology 

SES as a Risk Factor 

Poverty and Social Class Fluidity 

Counseling Implications 

Summary and Conclusion 

PART 2: Roles and Functions of Clinical Mental Health Counselors 

Chapter 4. The Counseling Process 

The Physical Setting of Counseling 

Aesthetic Qualities and Room Design 

Initial Sessions: Building a Counseling Relationship 

Seriousness of the Presenting Problem 

Structure

Initiative 

Initial Counseling Interviews 

Relationship Building during Initial Sessions 

Case Conceptualization 

Client Records 

The Working Phase of Counseling 

Treatment Plans 

Interventions, Skills, and Techniques 

Case Notes 

Documenting Work with High-Risk Clients 

Closing Counseling Relationships 

Why Closing Is Important 

Timing of Closing 

Facilitating Closing 

Documenting Closing 

Following Up 

Referring and Recycling

Summary and Conclusion 

Chapter 5. Client Assessment and Diagnosis 

Assessment in Counseling 

Assessment Defined 

Methods of Assessment 

Purposes of Assessment 

Principles of Sound Assessment 

Issues Related to Assessment 

Diagnosis 

Using the DSM-5 in Counseling 

Overview of Mental Disorders and Conditions 

Diagnosis and Treatment  

Biopsychosocial Assessment and Diagnosis 

Biopsychosocial Assessment and Reporting 

Summary and Conclusion 

Chapter 6. Holistic Approaches to Clinical Mental Health Counseling 

The Biopsychosocial Model 

Biological Components 

Psychological Components 

Social Components 

Assessment and Treatment Planning 

Spirituality 

Terminology 

Benefits Associated with Spirituality 

Spirituality and the Counseling Process 

Mindfulness 

Wellness 

Wellness Models: The Wheel of Wellness and the Indivisible Self 

Ways to Use the Indivisible Self Model in Counseling 

Prevention 

Definition of Prevention 

Rationale for Prevention 

Prevention Models 

Stress Management 

Summary and Conclusion 

Chapter 7. Consultation, Advocacy, and Evaluation 

Mental Health Consultation 

What Is Mental Health Consultation? 

Caplan’s Four Types of Mental Health Consultation 

Key Characteristics of Successful Consultants 

Advocacy 

What Is Advocacy? 

Empowerment 

Social Action 

ACA Advocacy Competencies 

Advocacy Skills and Attributes 

Challenges of Advocacy 

Advocacy for the Profession 

Client Outcome Evaluation 

Definition and Purpose of Client Outcome Evaluation 

Multifaceted Approaches to Client Outcome Evaluation 

Challenges and Benefits of Client Outcome Evaluation 

Program Evaluation 

Purposes of Program Evaluation 

Steps in Evaluation 

Process and Program Outcome Evaluation 

Quality Assurance 

Issues and Challenges of Program Evaluation 

Summary and Conclusion 

Chapter 8. Crises and Disasters, Managing Suicide Risk, Stress, and Burnout 

Crisis and Disaster Response 

Definition of Crisis

Definition of Crisis Intervention 

Crisis Assessment 

Six-Step Model of Crisis Intervention 

Disaster Mental Health Training

Compassion Fatigue, Secondary Traumatic Stress, and Vicarious Traumatization 

Suicide Assessment and Intervention 

Data Related to Suicide Prevalence 

Talking with Clients about Suicide 

Suicide Assessment

Identifying Risk and Protective Factors 

Immediate Interventions 

Responding to Risk Assessment 

Maintaining Effectiveness as a Counselor: Managing Stress and Avoiding Burnout 

Stress and Burnout in Counseling 

Establishing Limits 

Modeling Self-Care 

Cultivating Self-Awareness 

Maintaining a Sense of Humor 

Summary and Conclusion 

PART 3: Working with Specific Populations 

Chapter 9. Working with Groups 

The Place of Groups in Counseling 

Types of Groups 

Psychoeducational Groups 

Counseling Groups 

Psychotherapy Groups 

Task/Work Groups 

Mixed Groups 

Realities and Misperceptions about Groups 

Uses, Advantages, and Limitations of Groups 

Uses of Groups 

Advantages of Groups

Limitations of Groups 

Theoretical Approaches in Conducting Groups 

Stages in Groups 

Issues in Groups 

Selection and Preparation of Group Members 

Group Size and Duration 

Open versus Closed Groups 

Confidentiality 

Physical Structure 

Coleaders 

Self-Disclosure 

Feedback 

Follow-Up 

Qualities of Effective Group Leaders 

Group Organizations 

Summary and Conclusion 

Chapter 10. Couples and Family Counseling 

What Is a Family? 

Family Life and the Family Life Cycle 

Different Types of Families and Their Issues 

Minority Ethnic Families 

Dual-Career Families 

Single-Parent Families 

Childless Families 

Remarried Families 

Gay and Lesbian Families 

Aging Families

Multigenerational Families 

Military Families 

Family Life Stressors 

Expected Life Stressors 

Unexpected Life Stressors 

Couples Counseling 

Psychoanalytic Theory 

Social-Learning Theory 

Bowen Family Systems Theory 

Structural—Strategic Theory 

Rational Emotive Behavior Theory 

Emotionally Focused Therapy 

Family Counseling 

Psychodynamic Family Counseling 

Experiential Family Counseling 

Behavioral Family Counseling 

Structural Family Counseling 

Strategic Family Counseling 

Brief Solution-Focused Family Counseling 

Narrative Family Therapy 

Couple and Family Enrichment 

Research and Associations 

Summary and Conclusion  

Chapter 11. Counseling Children and Adolescents 

Developmental Considerations 

Early Childhood

Middle Childhood 

Adolescence 

Bioecological Considerations 

Psychological, Biological, and Genetic Influences 

Contextual Influences 

Counseling Considerations 

Building a Counseling Relationship 

Assessment and Evaluation 

Designing and Implementing a Treatment Plan 

Creative Interventions 

Concerns Affecting Children and Adolescents 

Depression 

Eating Disorders 

Attention-Deficit/Hyperactivity Disorder 

Specific Issues of Concern 

Summary and Conclusion 

Chapter 12. Counseling Adults 

The Transition Framework 

Emerging Adulthood 

Counseling Implications for Emerging Adults 

Early Adulthood 

Developmental Issues 

Early Adult Lifestyles 

Counseling Implications for Young Adults 

Middle Adulthood 

Physical Changes 

Psychosocial Issues 

Midlife Relationships 

Counseling Implications 

Later Adulthood

Developmental Issues 

Activities in Late Adulthood 

Relationships 

Response to Adversity 

Ageism 

What Is Ageism? 

How Is Ageism Expressed? 

Gender-Aware Counseling 

Counseling Women 

Counseling Men 

Summary and Conclusion

PART 4: Clinical Mental Health Counseling: Settings and Services 

Chapter 13. College and Career Counseling 

Counseling in College and University Settings 

History of College Counseling 

Campus Counseling Centers and Areas of Clinical Focus 

Prevalent Mental Health Issues among College Students 

Severe Mental Illness and Suicide 

Crisis Management on College Campuses 

Other Issues of Concern 

Career Counseling 

The Need for Career Development Services 

Career Development Process 

Career Counseling and Related Terminology 

Career Development Theories 

Career Counseling Process and Skills  

Summary and Conclusion

Chapter 14. Community Agencies, Medical Settings, and Other Specialized Clinical Settings 

Community Mental Health Centers and Agencies 

Evolution of Community Mental Health Centers 

Service Delivery 

Direct and Indirect Services 

Professional Affiliation and Certification 

Hospitals and Other Healthcare Settings 

Inpatient Medical Settings 

Other Behavioral Health/Psychiatric Services 

Cancer Patient Support Services 

Memory Assessment Counseling Services 

Other Hospital-Based Counseling Services 

Other Specialized Clinical Settings 

Hospice and Palliative Care 

Substance Abuse Treatment Programs 

Child and Family Service Agencies 

Other Clinical Services 

Summary and Conclusion  

Chapter 15. Employee Assistance Programs, Private Practice, Coaching, and Managed Care 

Employee Assistance Programs 

Becoming an EAP Counselor 

Serving as an EAP Counselor 

Private Practice Counseling 

Private Practice Work Settings 

Services Offered by Private Practitioners 

Pragmatic Considerations 

Tips for Building a Successful Private Practice 

Coaching 

What Is Coaching? 

Clinical Mental Health Counseling and Coaching 

Different Types of Coaching 

Regulation of Coaching

Managed Care 

The Development of Managed Care Systems 

What Is Managed Care? 

Implications for Counselors 

Advantages and Disadvantages of Managed Care 

Ethical Considerations 

Recommendations for Counselors 

Summary and Conclusion 

Epilogue

Appendix: ACA Code of Ethics (2014) 

References 

Name Index 

Subject Index 

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