Mental health counseling: toward resolving identity confusions. (Practice).
An essential element of professional training is providing the knowledge and experiences for trainees so they may develop a strong understanding of their chosen field and their own identity within its traditions (Stark, Lowther, Hagerty, & Orczyk, 1986). A professional identity provides a stable frame of reference which enables persons to make sense of their work and their lives, as it contributes to both a sense of belongingness and uniqueness (Friedman & Kaslow, 1986; Heck, 1990). Yet, for persons entering training programs, who do not yet have the insights which are gained in practice and its settings, acquiring a synthesized knowledge of mental health counseling (MHC) as a distinct profession can be a confusing task: "If people are doing essentially the same things ... that will be problematic for the development of a distinct identity" (Heck, 1990, p. 533). Accordingly, for students, an understanding of the distinctiveness of the profession--its definition and its concomitant professional roles--is difficult to glean from the literature's representation of the multiple service delivery professions (cf. Beck, 1999; Capuzzi & Gross, 2001). Students' confusion about the position and identity of mental health counselors is an important issue when training persons to view themselves as belonging to a specific professional community. If mental health counselors develop little or no allegiance to their profession, it could jeopardize MHC and put the profession at a disadvantage with respect to leadership and its ability to represent itself to the public, licensing boards, and third-party payers.
Previous authors have discussed identity as an aspect of the relative youthfulness of the profession and its adaptiveness in keeping pace with contextual changes in the delivery of human services (e.g., Ginter, 1991; Palmo, 1999). In some analyses, a salient identity element has been MHC's placement on the occupation-profession continuum (cf. Vollmer & Mills, 1966). Messina (1999) and others (Hershenson & Power, 1987; Palmo, 1990) have convincingly argued that MHC has accomplished the essential characteristics that indicate one's work is part of a profession and thus has attained professional status, as was the intention of its founders (Beck, 1999; Capuzzi & Gross, 2001; Hershenson & Power, 1987; Palmo, 1990). That is, there exists (a) a systematic body of theory, (b) authority to perform the work as recognized by the clientele, (c) the sanction of this authority by the broader community, (d) an ethical code (American Mental Health Counselors Association, 2000), and (e) a distinctiveness or a particular professional culture defined by values, norms, and symbols (cf. Greenwood, 1962; Vollmer & Mills, 1966). Nonetheless, because they are relevant to the identity of all members of the American Mental Health Counselors Association (AMHCA), two perplexities related to MHC's professional status merit discussion: (a) the systematic body of theory and its concomitant expectation for research and (b) the distinctiveness of its profession from other service providers. Our discussion of these issues is embedded within our belief that MHC has exhibited vitality and success in its growth. Our comments, therefore, reflect respect and questions, not criticisms.
A SYSTEMATIC BODY OF THEORY
One criterion of a field's establishment as a profession is its having a systematic body of theory to a quantitatively greater extent than does an occupation (Vollmer & Mills, 1966). The profession's skills and knowledge of a "specialized technique" (Gross, 1958, p. 78) are supported by and flow from "a fund of knowledge that has been organized into an internally consistent system, called a body of theory" (Vollmer & Mills, 1966, p. 11). The acquisition and mastery of theory distinguishes professional and nonprofessional preparation, because the intellectual mastery of theory is more difficult and lengthy than the practical learning of an apprenticeship. In addition, theory is so integrally important to professional activity that the specialized activity of the "researcher-theoretician" (Vollmer & Mills, 1966, p. 12) often emerges, producing a division of labor between the theoretician and the practitioner.
During its development, professionals have discussed MHC's establishing a systematic body of theory and the training necessary to produce persons skilled in scholarly accomplishments (Falvey, 1989; Hershenson, Power, & Seligman, 1989). Authors (e.g., Ginter, 1991) have indicated that "the field of mental health counseling must develop a firm scientific component if it is to continue to grow and attain the stature to which it aspires" (Gelso, 1989, p. 108). It seems to us that there is a dilemma, perceived by matriculating students, associated with establishing and producing theory in a profession characterized by master's training and an emphasis on practice.
Mental Health Counseling's Body of Knowledge
In examining this element of professional status, we think that it is important to consider the profession's essential nature. 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). In addition, "the mental health counselor is part of the health care team.... Training should include the best scientific information from the other mental health professions" (Seiler & Messina, 1979, p. 6).
Because there is an interdisciplinary dimension in MHC, it seems appropriate for its body of theory to embrace the "research of the behavioral sciences" (Palmo, 1990, p. 117). Identifying and utilizing an interdisciplinary body of theory is consistent with Fowler's (1990) suggestion that psychology "contains concepts and content that are basic to the effective functioning of other disciplines" (p. 2). Also, because "many problems can be appropriately and effectively met by two or more professions" (Brayfield, 1968, p. 197), an interdisciplinary body of theory can be considered an asset and strength. Moreover, an interdisciplinary base is not a threat to positioning as a profession. MHC can clearly identify the "system of abstract propositions that describe in general terms the classes of phenomena comprising the profession's focus of interest" (Vollmer & Mills, 1966, p. 11). For instance, personality and counseling theories generated by professionals trained and working in disciplines such as psychology (e.g., Rogers, Strupp, Lazarus) or medicine (e.g., Beck; Bowen, Kernberg) comprise a relevant, systematic body of theory for the basis of mental health counselors' work with clients. In addition, articles in the Journal of Mental Health Counseling (JMHC), for instance, on MHC's history and identity, explicate and clarify MHC's professional niche. We argue that MHC does not need ownership of all the theory that is relevant to its work; it can demonstrate that it has a solid and identifiable systematic body of theory, one that is consistent with its origins and its identity-related principle of interdisciplinary collaboration.
Mental Health Counseling's Contributions to Systematic Theory
On the other hand, it seems worthwhile for MHC to contribute to the systematic theory. Perhaps the literature that can be most clearly identified as produced by MHC is that which is published in the JMHC. In a review of contributors to the journal, Mate and Kelly (1997) found that the majority of the MHC literature is produced by those in academic settings, who are doctoral scholars and professors aligned with related professions and who are not, usually, licensed mental health counselors. There are three identity-related issues that stem from this finding that academicians, more than MHC practitioners, publish in the profession's journal.
Professional identification and theoretical knowledge. First, we wonder if or how the profession is at risk or vulnerable if its identifiable contribution to theory is produced, mostly, by persons who are not licensed practitioners. To us, it is unclear how theory or knowledge is jeopardized or tainted, or how MHC's continued development would be hindered, because its theoretical contributions are produced by persons whose primary doctoral identification may be academics or some behavioral science. From our perspective, the journal's contributors reflect and comprise an interdisciplinary base, which is a strength that continues and is consistent with the origins of the profession and its collaborative, interdisciplinary identity dimension (Seiler & Messina, 1979).
It is important, in understanding this point, to consider the purposes of doctoral, versus master's education and related job responsibilities. Doctoral training expands clinical expertise and prepares people for professional leadership as well as for research and publication (Ginter, 1991; Sherrard & Fong, 1991). Moreover, to paraphrase Remer (1981, p. 570), the publication system encourages some and dissuades others from scholarly productivity. Doctoral faculty "are forced to overcome their inertia and/or distaste for certain aspects of the [publication] process, such as library research or multiple revisions" (Remer, 1981, p. 570), because academic responsibilities and survival pressures include scholarship. It is, therefore, reasonable that contributions to theory come primarily from doctoral level academicians, who balance the tensions of interdisciplinary identifications. This practical reality of responsibilities is also consistent with a division of labor related to theory and practice evolving as professions develop (Vollmer & Mills, 1966). It is a strength and a signal of its professional status that MHC, through the JMHC, can draw academic scholars into its domain and boundary.
The role of JMHC. Second, MHC contributes and disseminates knowledge via its journal, thereby representing and publicly acknowledging its commitment to research, theory, and reflection on itself as an essential component of the profession's identity and basis for practice. The knowledge about the profession and the evolving theoretical base of practice is relevant to educating entering students as well as to informing career professionals about the history and current status of MHC, including the profession's responsiveness to contextual changes affecting the delivery of health care services. This knowledge is also archived as a data base for AMHCA's professional and political efforts.
Nonetheless, a division of labor--that is, a split in theory- and practice-oriented job activities (cf. Vollmer & Mills, 1966)--can form a tension for the profession because individual mental health counselors may weight identity elements differently for the career path than the profession highlights in accomplishing its mission. That is, research productivity is typically not a hallmark of mental health counselors' professional identity, though research is a valued and appropriate element within the profession's identity. Related to the differential weighting of identity elements, persons identified exclusively with the practice of MHC, because of their job responsibilities, might be interested in different issues than researchers or have difficulty finding a conduit to convey to academicians what they consider to be relevant to their daily work. Consistent with this thinking, surveys (Falvey, 1991; Seligman & Hickman, 1985) have indicated that members requested (a) that there be fewer research and more clinical articles in the JMHC and (b) that research topics address what is considered relevant to members, that is, clinical issues and treatment studies. To Falvey (1991), "the message is clear: Clinicians do not see the relevance to their work in research activities" (p. 223). Perhaps in response to the membership, research publications declined in the JMHC from 1984 to 1993 (Mate & Kelly, 1997). Nonetheless, the profession regards research as having an important role in solidifying its position and status within the context of related professions (e.g., Gelso, 1989; Kelly, 1993). Therefore, the journal serves multiple purposes. It has a primary responsibility to serve and be responsive to its constituency, that is, members of AMHCA; and in this sense it can be construed as a vehicle through which science-oriented and practice-oriented persons interact and communicate. The journal also has a mission and responsibility as a vehicle for publicly acknowledging and infusing research as a vital element of both the identity of the profession and the theoretical base on which practice is founded. Finally, it can be viewed as intellectually and emotionally containing or holding the identity complexities and tensions that accrue from splits in theory and practice.
Training in relation to identity and research productivity. The third issue, deriving from the finding of the interdisciplinary contribution to the JMHC, concerns the training of mental health counselors. It is important to remember that MHC is a terminal master's preparation program (Sherrard & Fong; 1991), as is reflected in surveys indicating that approximately two thirds to three quarters of AMHCA members are master's-level practitioners (Seligman & Hickman, 1985; Wheeler, 1980). Relatedly, there are no doctoral programs accredited in MHC (CACREP, 2001a). Without doctoral degrees, mental health counselors are excluded from employment in the institutions of higher learning that value scholarly productivity. As a result of the job opportunities of master's training, "mental health counselors are trained by doctoral-level faculty who often identify with a separate specialty area" (Falvey, 1989, p. 96). Because doctoral training expands skills, it fits the profession of academia to perceive one's professional identity as academics and the doctoral specialty (e.g., counseling psychology), while simultaneously accepting training responsibilities in another profession. The interdisciplinary nature of MHC and its overlap with the philosophy and identifying characteristics of related professions makes the tension of a dual alliance a coherent and comfortable philosophical position for academicians. Nonetheless, faculty--though training mental health counselors, producing theory, and providing professional leadership--may not be strongly connected to frustrations, realities, and changes associated with service delivery. As the profession adapts to meet market demands, faculty's and students' knowledge, including identity-related shifts, may lag behind practitioners'. One solution for assuring that mental health counselors are on the cutting edge during their preparation is for practice and entry-position supervisors to focus on and clarify the profession's current changes and growing edges. In addition, faculty can attend to the feedback from the field; that is, value and seek the science- and practice-oriented interaction that is implicit in conversation with practice supervisors or through reading the JMHC. Training and the profession are then engaging MHC's interdisciplinary, collaborative strengths.
There is also a dilemma in training people to identify themselves as master's practitioners while also expecting them to contribute to theoretical base (Falvey, 1991). Although most mental health counselors have had training in basic research, they have been prepared to think scientifically and use research, not to produce theory and research, or write for publication (Falvey, 1991; Gelso, 1993). Moreover, there are not many MHC employment opportunities that favor scholarly productivity (Falvey, 1991; Holland, 1986; Strupp, 1986). In addition, the principles of learning theory suggest that the lack of opportunity for master'-level practitioners to transfer their research training to their work environment results in rapid extinguishment of the learning associated with producing research (Falvey, 1989). Most importantly, the job demands of practice are for service delivery that produces income; it is the research university that rewards research and scholarly productivity (Ginter, 1991).
To agree with Gelso (1989), "given the training level, job settings and interests of most mental health counselors, ... [we are] less than sanguine about increasing their production of research" (p. 109). However, we also are not convinced that there is a fundamental flaw or vulnerability in this position. Indulging professional beliefs (e.g., the production of research is important) is an investment in what is relevant and valuable in the interdisciplinary systematic body of theory, for the basis of MHC practice, and for the profession's status. Practical realities that do not match these ideals should not be viewed as either failures or shortcomings. It seems appropriate for professional identity and expectations to match training and job realities and to change when realities change, as when societal pressures indicate the inclusion of diagnostic courses in the curriculum (cf. Brown, 1989).
In MHC, the ideal of practice based on scholarship is evident when (a) professionals support and make critical use of theoretical or research contributions and (b) practice resembles the process of science in terms of its skeptical and cautious judgment (cf. Fowler, 1990). Rather than publishing research, mental health counselors are expected to practice in a way that constitutes the implementation of science, that is, reflect research, locally and idiosyncratically, in one's approach to clients and counseling (see Strickler, 1992). 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, that is, using theory and systematic observation to build hypotheses, collect data, interpret data, seek alternative explanations for the data, and revise hypotheses (e.g. Falvey, 1989, 1991; Fowler, 1990; Martin, 1988). This thinking is consistent with both (a) Howard's (1986, p. 64): "Intellectual tasks that counseling researchers and counseling practitioners set for themselves are quite similar" and (b) Falvey's (1989, p. 99): "Research and psychotherapy are conceptually and passionately similar endeavors. Both follow a decision-making process ... termed clinical judgment or scientific method." Expecting mental health counselors to reflect, think critically, and use scholarship in assessing the accuracy and relevance of the abundance of information available to them (Haas & Malouf, 1995) is consistent with their work environments. Although the profession may aspire to research productivity as a hallmark of identity, mental health counselors may find that it is the constellation of (a) using research/scholarship, (b) thinking as a researcher, and (c) implementing research attitudes that is an achievable hallmark of professional identity; one which is augmented and reflected by AMHCA through its support of conferences and publications (e.g., JMHC).
DISTINCTIONS AMONG PROFESSIONS
Persons newly admitted to training in the 21st Century are faced with forming a professional identity within a complex and bewildering array of overlapping and related, but separate, human service delivery paths. In such a context, development of a professional identity, especially initially, may be a confusing task, because an aspect of identity is distinguishing one's own profession from others. Identity includes a solid understanding of the history and stability of the profession as well as a sense of the profession's distinctiveness, including both inclusive (e.g., who we are) and exclusive (e.g., who we are not) aspects (Heck, 1990). The borders among the human service delivery fields can be distinguished based on "professional identification, length and content of professional and specialty education, practitioner's entry-level graduate degree ..., basic academic discipline, conceptualization of mental health problems, and approach to treatment" (Hershenson & Power, 1987, p. 3). Using these components, MHC has previously been effectively and clearly distinguished from other fields such as psychiatry, social work, psychology, psychiatric nursing, and marriage and family therapy (e.g., Gelso & Fretz, 2001; Hershenson & Power, 1987). To illustrate the differentiating process, MHC shares some elements (Brown & Srebalus, 1996; Fong, 1990; Hershenson & Power, 1987) with counseling psychology (Gelso & Fretz, 2001)--its emphasis on developmental processes, the person-environment matrix, and the scientist-practitioner attitude; and both professions attract students who work primarily in service delivery after graduation. However, MHC's borders are distinguished because training does not require a foundation in the discipline of psychology, a research product prior to graduation, or the doctoral degree for entry to the profession.
MHC is not, however, so easily distinguished from other counseling fields (e.g., professional counseling, community counseling). Research (Ginter, 1991) indicates that professionals believe that "philosophy or orientation" (p. 194) is a "key distinction" between mental health professionals. Yet, the counseling fields share both a common philosophical emphasis, that is, an educational, developmental, and scientist-practitioner framework (cf. Steenbarger, 1990, 1991; Van Hesteren & Ivey, 1990), and a common goal, which can be summarized as "to foster positive human growth and development" (Robinson, 1990, p. 530). This similarity provides stability and an inclusiveness aspect of identity, that is, a distinction related to the meaning of counseling. But there remains the question of what is the distinct identity of different counseling professionals as exemplified by Gelso and Fretz's (2001) distinguishing counseling psychology from "the general counseling profession (often referred to as counselor education or mental health counseling)" [emphasis added] (p. 21).
A perusal of introductory counseling texts (e.g., Brown & Srebalus, 1996; Capuzzi & Gross, 2001) does not provide a clear guide to the distinguishing elements of counseling identities. For example, texts indicate that counselors have a knowledge base in and a focus on career and group, work with special populations such as couples and families or older adults, and are employed in educational or community settings. Browers (2001) discusses the professional identity of mental health counselors, but the borders between professional counseling and mental health counseling seem fuzzy. The shifting of terminology between mental health counselor and professional counselor and reference to the history of mental health counseling serve to highlight the identity diffusion. To borrow the phrasing, if not the meaning, from a previous author, the current dilemma seems centered around: "A counselor is a counselor, what's the difference?" (Weikel & Palmo, 1989, p. 10). In addressing this question, we will consider the history of MHC, the ambiguity inherent in the relationship of the professional organizations, the status of community counseling, and mental health counseling licensure.
Historical Tradition of MHC
MHC was established as a hybrid profession by primarily master's level practitioners working under a variety of paraprofessional titles in public settings such as hospitals, private practice, and community mental health centers (Beck, 1999; Weikel & Stickle, 1989). These persons had been rendered professionally invisible, lacked a place of belonging, and were disenfranchised. That is, they had been unable to gain credentials or licensure in the core provider professions (i.e., social work, psychology, and psychiatry). In joining together, their goal was to "establish a distinct profession through counseling" (Beck, 1999, p. 204), and they were beginning the process of differentiating their professional roles and identification from other service providers. This group defined its work early on as "an interdisciplinary multifaceted, holistic process of (1) the promotion of healthy lifestyles, (2) identification of individual stressors and personal levels of functioning, and (3) preservation or restoration of mental health" (Seiler & Messina, 1979, p. 6). The new MHC profession was claiming for itself a unique identity, distinct from other providers.
In its early years, when discussing identity issues, MHC seemed to define 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; Palmo, 1990; Seiler & Messina, 1979). More specifically, the client is viewed both (a) systematically, as embedded within and influenced by the family, societal, historical, socioeconomic context (Eberst, 1984), so that community resources can be useful in treatment (Borders, 1994); and (b) individually, as being the gestalt of multiple domains--emotional, physical, social, vocational, and spiritual--that coalesce and culminate in a more or less healthy lifestyle (Hershenson & Power, 1987; Seiler & Messina, 1979). As Weikel and Palmo (1989) stated, "most knowledgeable MHCs would be able to define the differences among the various professional counseling groups" (p. 10). The early mental health counselors were counseling service providers, not psychologists, social workers, psychiatrists; nor were they school or vocational counselors. In today's world, however, entering students must distinguish an identity from an array of counseling professionals (e.g., mental health counselor, professional counselor, community counselor) and choose a corresponding, primary organizational home such as AMHCA or the American Counseling Association (ACA).
Professional Affiliation -- AMHCA and ACA
The history of AMHCA and ACA mirror a confusion experienced by students matriculated in MHC programs: Does AMHCA represent an independent profession or does it house a counseling specialty within ACA and professional counseling? ACA "is a confederation of relatively autonomous counseling organizations reflecting a wide range of professional interests" (Heppner, Casas, Carter, & Stone, 2000, p. 23). As an umbrella organization, ACA has offered a professional structure and organization, providing political and other services for counseling. When AMHCA was founded in 1977, ACA (previously known as the Personnel and Guidance Association and then the American Association for Counseling and Development) was not accepting new divisions, which left AMHCA as an independent freestanding organization. Although AMHCA became an ACA division in 1978, there have been both philosophical and financial struggles between the two organizations (cf. Beck, 1999). Today, AMHCA is listed as a division of ACA, but has separated its finances from ACA, with members joining AMHCA independently of ACA. In addition, AMHCA has a collaborative, rather than an affilitative, relationship with ACA. Although the divisional structure, which may be more political or practical than philosophical, can be construed as implying that MHC is a specialty within professional counseling, the financial separation of the organizations suggests that AMHCA and MHC are independent of professional counseling as represented by ACA.
If such a distinction is accurate, it is not apparent in either the structure of ACA or the accreditation standards for MHC programs (CACREP, 2001b). ACA (2001b) provides a definition for professional counseling and defines counseling specialties as requiring advanced knowledge. The definitions in conjunction with the divisional structure suggest that ACA represents all counselors as it "embraces practitioners representing a broad array of counseling specialties" (Browers, 2001, p. 333). Similarly, the CACREP accreditation standards state general program objectives and curriculum requirements, including identifying with the counseling profession and understanding its history and philosophy. In addition, there are, arguably, advanced knowledge requirements specific to MHC such as a 60 versus a 48 hour program and the need to address the historical and philosophical trends in MHC. It is easy, therefore, to construe MHC as a specialty within professional counseling, which would mean that the identity dilemma resolves itself as "I am a professional counselor with specialty training in MHC." This identity seems inconsistent with AMHCA's financial independence and its collaborative stance with ACA. These latter elements suggest the profession has an independent status in representing professionals who emphasize an interdisciplinary dimension, a focus on mental health, and an endorsement of a holistic and contextualized view of the person (see Beck, 1999; Palmo, 1999). These themes are a gestalt-like primary focus for mental health counselors, embedded in MHC's historical traditions, and so can distinguish their identity even if the elements overlap with other professions' domains (cf. Gelso & Fretz, 2001).
The Status of Community Counseling
The identity quagmire extends also to trying to distinguish MHC and community counseling (cf. Sherrard & Fong, 1991; Wilcoxon, 1990). Spruill and Fong (1990) suggest that nonschool counseling occurs in the community, and any distinction between MHC and community counseling is spurious, based more on the historical development of counseling than on specialty distinctions. In 1990, Fong suggested that the counseling profession was generating "confusing and wasteful duplicate structures" (p. 106) and stated "the scope of counseling and mental health counseling is the same; the terms are synonymous and, thus, the proper name for the entire profession of counseling is mental health counseling" (p. 107). Fong further argued that while some specialties are named for the environment in which intervention occurs (e.g., school counseling, community counseling) and others for the main concern addressed (e.g., vocational counseling, marriage and family counseling), all encompass the same core and are a form of mental health counseling. Similarly, a recent survey of directors of CACREP-accredited community counseling programs indicated that "respondents were evenly divided between those who seem to see community counseling as generic counseling preparation for nonschool settings and those who seem to see it as a community-oriented specialization in its own right" (Hershenson & Berger, 2001, p. 188). It is, therefore, difficult to conclude that there is a clear identity specific to community counseling. Is it possible that these are the professional counselors?
There do, however, seem to be some elements distinguishing community counseling and MHC. For instance, CACREP accredits community counseling with a 48-hour program, while MHC accreditation requires a 60-hour program. Unlike community counseling, MHC is a division of ACA and has its own professional organization (AMHCA), journal (JMHC), and newsletter (The Advocate). Indeed, it appears that community counseling is a response to the perceived needs of counselor educators, members of the Association for Counselor Education and Supervision (ACES) division of ACA (Hershenson & Berger, 2001). In contrast, MHC and AMHCA were intentionally established as a profession by the founders (Beck, 1999). Although community counseling undoubtedly serves purposes, especially for those academic departments and students who feel constrained for political, economic, or other reasons to a briefer program, its status seems to lack the substance and professionalism of MHC.
This status differential may be relevant to professional identity. It seems possible that because of the professional organization (AMHCA) and its efforts regarding credentialing, MHC has been more responsive to the market place, while community counseling has depended for change more on academicians who are not so infused into current market agendas. More specifically, MHC training, affected by shifts in the marketplace (Seiler, 1986), has become more clinically focused, as evidenced by a curriculum including psychodiagnosis, psychopathology, psychopharmacology, and treatment planning (Hershenson & Berger, 2001). In this way, MHC has been competitive in the health care industry during the managed care era (Messina, 1999), while retaining stability in identity as a counseling field. Relative to community counseling, MHC identity includes a professional status as well as flexibility and responsiveness to contextual changes in service delivery, as is consistent with the practice origins and the work of the field.
Mental Health Counseling Licensure
Another way to determine distinctions among professions (e.g., psychology, social work) is through credentialing and licensure. Consistent with this premise, both the mission and vision statements of AMHCA focus on enhancing MHC through advocacy and licensing (AMHCA, 2001). However, whether one's identity is best crystallized as "a professional counselor who specializes in MHC" or as "a professionally independent mental health counselor" is not resolved by gaining a professional license.
Early on, MHC established a professional certification (Beck, 1999); thereby providing external validation or sanctioning of its unique professional identity and status. Nonetheless, as the market for mental health care increased, access to independent practice became more competitive and political, and licensing became the standard for defining who is qualified for practice (Heppner et al., 2000). This is the zeitgeist in which counselors advocated for recognition as practitioners. At present, counselor credentialing/licensure has been enacted in 45 states and the District of Columbia (ACA, 2001a), but only in 8 states has the title licensed mental health counselor been legislated (ACA, 2001c).
There is an identity dilemma, which is consistent with the perception of MHC as a professional counseling specialty, that is associated with the profusion of professional counselor licensing titles and with the practicalities of licensure that go along with this predicament. Mental health counselors can be licensed under most states' professional counselor licensing laws because their course work and experience usually meet the necessary requirements. This license will not, however, reflect their identity as a mental health counselor. In contrast, in states that license mental health counselors, persons trained in different kinds of master's-level programs may hold a license but not identify themselves as a mental health counselor. That is, the license allows counselors from a variety of training programs to be qualified for independent work, but the nomenclature does not distinguish the identities of a graduate of a CACREP accredited MHC program from a graduate of a master's clinical psychology program. In a sense, then, the license to practice does not reflect the particular profession and its standards. Nonetheless, to the extent that business interests drive licensure, counselor licensure is a success for mental health counselors. There is, however, some awkwardness in identifying as a mental health counselor, but being licensed as a professional counselor, unless MHC is a professional counseling specialty. Likewise, it is awkward that someone not trained as a mental health counselor can be licensed under this title, especially if mental health counseling is to be considered by the public and other professions to be an independent service provider, rather than an affiliate organized under the umbrella of professional counseling. One solution to the dilemma is for mental health counselors to obtain the Certified Clinical Mental Health Counselor (CCMHC) credential (National Board for Certified Counselors, 2001) in order to externally support their identity. However, there are two difficulties with this solution. First, licensure is necessary in today's world, and multiple credentials can be costly and redundant. Second, master's graduates apply for certification, first, as a National Certified Counselor, and then qualify for CCMHC status. With this process, certification seems to support a specialty identity for MHC, implying that professional counseling is the basic identity.
Although the licensing situation institutionalizes the confusion in distinguishing MHC from professional counseling, licensing titles need not determine professional identity. Even if the independence of MHC as a profession could benefit from identity issues driving licensing titles, AMHCA and ACA have some similar business interests and are, sometimes, able to advocate more strongly using a combined voice. These issues are difficult, thorny, and complex, with ideals and realities juxtaposed rather than aligned with one another. Service delivery professions typically cannot be distinguished based on activity, setting, or population; and in fact their distinctiveness is more a synthesis of their foci, themes, or emphases rather than an exclusivity (Gelso & Fretz, 2001). Because it takes specialized knowledge to grasp the distinctiveness of particular health care professions (e.g., mental health counseling versus professional counseling; counseling versus clinical psychology), some distinguishing features (e.g., identity) are difficult to convey to nonprofessionals, including legislators and consumers. Licensing laws and professional standards are designed and enacted in order to protect the public (e.g., the consumer); however, licensing requirements and titles vary state to state, despite professional standards. Moreover, the consumer is benefited by a variety of human service providers, and professional identity distinctions may not be relevant to consumers' needs. Perhaps it is expedient and even appropriate to separate identity from the political rite to practice, especially since distinctions between a mental health counselor and a professional counselor are most salient within and between professions. If this is possible, then professional identity need not stay entwined in and confused by turf battles or by the financial or political exigencies that prompt AMHCA and ACA to join forces to advocate for concerns pertinent to both professions. Perhaps the clear articulation that "MHC is one of the independent human service providers in the health care industry," bolstered by the financial separation of MHC from professional counseling, comprises the necessary-enough and sufficient-enough conditions to resolve identity issues, consistent with the intentions of the founding pioneers (Beck, 1999).
The issues of the profession's philosophy, expectations for production and use of its systematic body of theory, and uniqueness within other counseling and human service delivery professions are important considerations for defining a professional identity which will support professional work and promote both belongingness and leadership within MHC. Although training includes facilitating students' integration of an intrinsic motivation and personal responsibility for professionalism (VanZandt, 1990), training and the initial identity provide only entry-level expertise. A professional identity that is consistent with one's work can provide stability and security for early career persons as they continue on-the-job learning and find their niche within the employment setting (Skovholt & Ronnestad, 1992). This professional growth may be more smooth and self-directed when the profession has clarified its distinctiveness in a way that is consistent with practical experience, that is, when the profession has declared its limits so that boundaries are clear rather than fuzzy (cf. Heck, 1990).
For example, in terms of professional identity, mental health counselors have a bold past. Persons who were disenfranchised in practice found that the establishment of MHC provided them a sense of belongingness, a professional home (Beck, 1999), and provided a professional identity for those persons "who believed in the power of counseling" (Palmo, 1999, p. 217). Consistent with this history, MHC is a master's-level, primarily practice-oriented profession. It shares a border with professional counseling in its conceptual and philosophical perspective that is more educational-developmental-preventive than clinical-remedial-medical (Palmo, 1990; Seiler & Messina, 1979; Steenbarger, 1991). And, as part of the health care industry, MHC focuses on a wellness, holistic mental health philosophy in working with clients with developmental struggles or clinical diagnoses (e.g., Hershenson & Strein, 1991; Metcalf, Dean, & Britcher, 1991), and in understanding other professional frameworks in interdisciplinary teams (Brown & Srebalus, 1996). From this perspective, designing, implementing, and publishing data-based research is outside the boundary of what is a typical professional activity for licensed or certified mental health counselors; though, because of its interdisciplinary dimension and valuing of research productivity, the profession can comfortably include people who stretch this identity boundary. It is also possible that these scholars may function as a growing edge for the profession. Nonetheless, at present, expecting mental health counselors to publish research can be construed as a mandate that contrasts with job pressures and sanctions, and slides the research element of identity into a position which is not tenable given most professionals' training and daily work. Should trainees integrate this petitioning for research productivity into their professional identity, in this form, they may experience disillusionment in their early career transitions. In contrast, perceiving one's practice as idiosyncratic, evidentially based research with a client (cf. Strickler, 1992) might lead to a sense of mastery and belongingness that is consistent with a profession that values, incorporates, and strives toward scholarly productivity.
MHC has been responsive to market changes, and to remain vital and viable within the health care industry, it will continue to periodically reevaluate and reaffirm its identity in response to the political and social zeitgeist of health care. For example, AMHCA's advocating for separate titles in licensing laws is possibly not an efficacious or an efficient use of monies in the current zeitgeist; whereas, modifying CACREP standards to reflect MHC as distinct from professional counseling might be a beneficial and achievable goal. Regardless, professional identity confusion can coincide with growth or change in the profession and its position vis-a-vis related professions. Indeed, there may be more confusion for those entering programs and beginning to form professional identities than for persons practicing and in touch with the issues stimulating change. Professionals who have an identity established though training and work experience may experience changes in their activities or the need for continuing education and not feel a sense of change in their identity. Our argument in this article is, however, that the profession can profit from some clarifying or re-affirming of certain identity elements: (a) mental health counselors, typically, value and use scholarship and research attitudes and processes, while remaining cognizant of scholarly productivity as an aspiration and aspect of the profession's identity; and (b) MHC is an independent profession which is distinct from but closely aligned with professional counseling.
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M. Carole Pistole, Ph.D., is an associate professor and Amber Roberts is a doctoral candidate. Both are with the Department of Educational Studies at Purdue University, West Lafayette, IN. Email email@example.com
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|Publication:||Journal of Mental Health Counseling|
|Date:||Jan 1, 2002|
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