Chapter 4: Employment Settings for Mental Health Counselors
Chapter Overview
The author provides an increased understanding and awareness of the different types of careers available
for mental health counselors. Information covers the different work settings and the associated roles and
responsibilities for counselors working in those settings.
Multiple Choice Questions
1. The Community Mental Health Act of 1963 radically changed the way in which mental health
services are delivered. What has been its most significant contribution?
a) It introduced private practice.
b) It established managed care organizations.
c) Removed individuals from state institutions to community.
d) Closed all state institutions and replaced with private institutions.
e) Introduced substance abuse rehabilitation programs.
2. Substance abuse is one of the fastest growing areas of mental health treatment. In which setting
will mental health counselors typically be involved in substance abuse treatment?
a) Hospital inpatient treatment.
b) Outpatient treatment centers.
c) Private practice.
d) a) and b) only.
e) None of the above.
3. Community mental health centers play an important role in providing community services. Which
of the following is NOT a goal of these centers?
a) Provide direct and indirect services.
b) Provide counseling and outreach programs.
c) Provide homogenous delivery systems across all centers.
d) Collaborate with service providers and community advocates.
e) Advocacy and consultation.
4. The changes brought about by the Community Mental Health Act of 1963 have significantly
changed the way in which counselors need to work in the various settings. What is/are the most
significant change?
a) Counselors must work collaboratively with other service providers.
b) Accurately assess client’s core issues.
c) Flexibility to respond to diverse goals of service.
d) a) and b) only.
e) All of the above.
5. Private practice offers a range of opportunities and challenges for counselors. Which of the
following best describes the challenges specific to private practice?
a) Responding to a diverse client population.
b) Providing a broad range of services.
c) Practicing ethically.
d) Balancing counseling skills with business skills.
e) All of the above.
6. Which of the following skills are essential for counselors working in hospital settings?
a) Work within multifaceted teams.
b) Understand the different roles of team members.
c) Adapt to a medical environment.
d) Learn medical terminology.
e) All of the above.
7. What type of counseling services are offered in correctional facilities?
a) Group and individual services.
b) Psychoanalysis therapy.
c) Substance abuse rehabilitation.
d) a) and c) only
e) All of the above.
8. Counselors working in non-profit organizations require additional skills in order to effectively
respond to their clients’ needs. Which of the following skills is/are essential in this setting?
a) Financial planning and budgeting.
b) Incorporate non-clinical roles to build relationships.
c) Manage managed care organization administration.
d) a) and b) only
e) All of the above.
9. Which of the following service delivery systems is accurately matched with the services it
provides?
a) Impatient services provide 24/7 client monitoring through a multidisciplinary team.
b) Partial treatment services reside in hospitals and provide 24/7 client monitoring.
c) Outpatient services closely supervise client rehabilitation through individual therapy.
d) Partial treatment services are for individuals who have the capacity to live independently.
e) All of the above.
10. Which of the following is NOT a goal of managed care organizations?
a) Increase access to services for public and increase referrals for practitioners.
b) Ensure equal access to for all populations.
c) Monitor service provision for the community.
d) Manage costs.
e) All of the above.
11. What are some of the criticisms leveled at managed care organizations?
a) The medical model further pathologizes clients.
b) Few clients get coverage due to high costs.
c) Few practitioners use the system because it is administratively too cumbersome.
d) a) and c) only.
e) All of the above.
12. Which of the following organizations are correctly matched with the services they provide?
a) HMOs are for large group practices providing short-term prepaid services on a per capita
basis.
b) PPOs provide low cost-sharing services within network of providers and high cost out of
network services at physician’s referral.
c) POSs provide low cost within network and high cost out of network services by enrollee
referral.
d) All of the above.
e) None of the above.
13. The role of online counseling is steadily growing but it brings with it some new ethical
challenges. Which of the following ethical challenges are relevant?
a) Safety of client’s at risk.
b) Confidentiality.
c) Accuracy of client information.
d) Technical breakdowns.
e) All of the above.
14. Which of the following is NOT a concern with regard to counselor performance with online
counseling?
a) Theoretical orientation of the counselor.
b) Building rapport through client visual cues.
c) Creativity for treatment planning.
d) Responding to cultural diversity of client.
e) None of above.
15. As public policy has opened counselor access to new mental health services, such as to the
veterans and the army, what are the most important professional standards included in the
policies?
a) A minimum of five years practical experience.
b) Graduation from a CACREP accredited master’s program.
c) Specialization in trauma therapy.
d) Contracts for a minimum of two years.
e) All of the above.
Activities
1. Voices from the field provide valuable insight into the reality of practical experience. Divide class into
groups of 6 to 8 persons and ask each group member to interview a professional working in a different
work setting. Interview questions may include, but not limited to:
• Aspects of working in their setting they enjoy most, find most challenging, and wish they had
known before they worked in the setting.
• What professional competencies and or attributes are specifically relevant to working in this
setting?
• How does a new graduate counselor get a placement in this setting?
• What are the career opportunities for a counselor working in this setting?
Bring the group together and have the group share their experiences from the field. Ask the group to
discuss how listening to these varied experiences influence how they choose the setting in which they
would like to work after graduating. Which factors most influences students’ choice of setting for
practice?
2. Support groups have now become an important resource for supplementing therapeutic treatment.
Support groups for addiction have become a mainstay for addiction counseling and treatment. The twelve
step program used by Alcoholics Anonymous in particular has gained prominence and the 12 step
approach has been successfully used to support a wide range of other addictions, such as eating disorders,
narcotics and sex addiction. Attend at least two of these support groups for addiction using the 12 step
program. Write a 3-4 page paper processing your experiences and thoughts about the experiences. How
will your insights inform your practice with addicts?
3. Due to major events in society and subsequent legislation a number of new opportunities have opened
up for counselors to work in new settings, such as with the Veterans. Alternatively societal trends provide
new opportunities as yet untapped for new counselor work settings, such as providing services to the
rapidly increasing aging population. Divide the class into groups and ask each group to
brainstorm/research new work setting opportunities for counselors. Ask each member to research one of
the identified settings. Bring the group back to share their findings and discuss their thoughts about the
new and non-traditional work settings for counselors. Would this encourage the students to consider
alternative career paths as a result of this exercise?
Discussion Questions
1. Which mental health service setting would you like to work in or currently work in? Discuss the
advantages and disadvantages of working in this setting relative to your personal skills, attributes, and
interests. Discuss any potential areas of future personal development that arise from your reflections.
2. Compare the advantages and disadvantages of online counseling. Identify potential ethical dilemmas
that would be a concern for you personally and discuss how you may address them when working with
online clients.
3. While the purpose of managed care was to replace costly fee-for-service systems there are some who
argue that their role in the community and the profession has not be totally positive. Discuss some ethical
and professional concerns associated with needing to work with managed care.
Multiple Choice Questions – Answer Key