Chapter Three: Theoretical Foundations for Clinical Mental Health
Counselors
Chapter Overview
Now that the groundwork has been laid for understanding who clinical mental health
counselors are and what their historical origins have been, the third chapter turns to the theories
that guide clinical mental health counselors in the counseling room. There are a variety of
counseling theories, and choosing a theoretical standpoint for conceptualizing clients is an
important step in the formation of students’ professional identity. However, no student enters a
graduate program completely devoid of any theory regarding human experience. The chapter
outlines how the personhood of the student guides the theories he or she chooses as a counselor
through the student’s self-schemas, worldview, and interpersonal style. Developing self-
awareness will greatly aid the student in choosing a theoretical viewpoint from which to operate.
This chapter outlines the philosophical underpinnings of clinical mental health counselors as a
whole, while Chapter Four will discuss specific contemporary and traditional theories that
counselors may choose from as they formulate their personal counseling style.
A counselor’s professional identity and chosen theories are not the only variables at play
in the counseling relationship. Understanding client motivation and the transtheoretical model of
behavioral change are also important in conceptualizing client cases. The transtheoretical model
posits that clients move through five stages of change (precontemplation, contemplation,
preparation, action, and maintenance) as they consider new courses of action. Counselors must
influences their environment even while they are being influenced by their environment. While
some theorists conceptualize human development using stage models, others utilize incremental
models to describe human development. Clinical mental health counselors use normal human
development as a baseline for understanding abnormal development. They need a strong
understanding of human development in order to look at clients holistically and recognize typical
and atypical life transitions.
Secondly, mental health counselors also look at clients within their ecological contexts,
recognizing the interaction of the client’s microsystem, mesosystem, exosystem, and
macrosystem. Each level of the client’s context impacts the client’s functioning, and
intervention sometimes needs to take place at multiple levels of the system. No client operates
within a vacuum.
Thirdly, mental health counselors work to promote mental health, emphasizing wellness
and flourishing. Similarly, they work for prevention of mental health problems through primary
prevention, secondary prevention, and tertiary prevention. From this perspective, mental
health/wellness and mental illness/pathology are viewed as lying on distinct but interacting
dimensions rather than on a single continuum. Therefore, a person with mental illness (such as
schizophrenia, bipolar disorder, etc.) may still experience high levels of mental health and
wellness despite these diagnoses.
The principles discussed in this chapter (i.e., human development, the ecological context,
and wellness/prevention work) are foundational for understanding the clinical mental health
paradigm. The following chapter discusses specific contemporary and traditional theories that
counselors use for conceptualizing clients.
Learning Objectives
By the end of the chapter, students should be able to:
• Articulate why their self-schemas, worldviews, and interpersonal styles will affect which
counseling theories they select.
• Describe the transtheoretical model of behavioral change.
• Explain how a good theory will describe, explain, predict, and provide techniques.
• Describe important criteria for evaluating theories.
• Explain the foundational principles of clinical mental health counselors (human
development perspective, ecological perspective, wellness/prevention perspective).
• Describe the clinical mental health counseling paradigm.
Key Words/Terms
• Theory– a set of interrelated principles that describe and explain the client’s situation,
predict future developments, and guide the counselor’s interventions.
• Self-schema– an internal cognitive structure about self that develops from past experience,
which individuals use to organize and integrate new information.
• Worldview– one’s presuppositions about the world and one’s place in the world which are
largely unconscious, deeply ingrained, and affected by one’s sociocultural context.
• Transtheoretical model of behavioral change– posits that clients move through five stages
(precontemplation, contemplation, preparation, action, and maintenance) in order to
implement successful change.
o Precontemplation- the client in this stage is unaware of a problem or unwilling to
change.
o Contemplation- the client in this stage is aware of a problem and begins to
consider change.
• Exosystem– the level of context in which two or more settings interact, one of which does
not contain the client.
• Macrosystem– the level of context defined by the client’s culture, encompassing that
culture’s roles, values, and expectations.
• Mesosystem– the level of context in which two or more of the client’s microsystems
interact.
• Primary prevention– reduces the likelihood of a person developing a mental/emotional
disorder, through education, consultation, and crisis intervention.
• Secondary prevention– limits the negative impact of a disorder on people who have
already been affected by the disorder through early detection, thereby shortening the
duration of the condition.
Lecture Outline for Chapter Three
Theoretical Foundations for Clinical Mental Health Counselors
I.Theory and Personal Characteristics of the Counselor
A. From our working theories, we develop case conceptualizations, by organizing information
about our clients in a way that explains past, present, and future behavior.
B. Implicit personality theory– the ideas people develop about the way other people’s personal
traits and behavioral tendencies fit together
2. Can be accurate or inaccurate, so they can either help or hinder counseling
3. Can contribute to a perceptual bias.
C. Self-schema– an internal cognitive structure about self that develops from past experience,
which individuals use to organize and integrate new information.
D. Worldview– one’s presuppositions about the world and one’s place in the world which are
largely unconscious, deeply ingrained, and affected by one’s sociocultural context.
II.Process of Change: The Transtheoretical Model
A. This is the client’s level of motivation for change.
B. Five stages of change:
2. Contemplation – the client in this stage is aware of a problem and begins to consider
change.
4. Action – the client in this stage is actively implementing a plan for change
5. Maintenance – the client in this stage is consolidating gains and working to prevent relapse.
C. Effective counseling will match the client’s stage of change with appropriate interventions:
1. Precontemplation – Conduct a cost/benefit analysis; create discrepancy
3. Preparation – Develop systematic, step-by-step plan)
5. Maintenance – Help the client consolidate gains and prevent relapse.
III.The Role of Theory in Counseling
A. A good theory should:
1. Describe- What is the client doing?
2. Explain- Why is the client doing that?
3. Predict- What will the client do next?
4. Guide intervention- What will best help this client?
B. Good theories are:
1. Precise and clear
3. Testable
5. Heuristic Value
IV.Foundational Theories for Clinical Mental Health Counselors
A. The clinical mental health counseling paradigm is based on principles of human
development, ecological context, emphasis on wellness, and emphasis on prevention.
B. Theories of Human Development
1. Stage Theories:
a. Freud – Psychosexual Development
2. Incremental Theories:
a. Pavlov: Classical Conditioning
3. Principles of Lifespan Development
a. Development is a continuous, lifelong process.
1. Microsystem– the level of context in which face-to-face interactions takes place.
3. Exosystem– the level of context in which two or more settings interact, one of which does
not contain the client.
4. Macrosystem– the level of context defined by the client’s culture, encompassing that
culture’s roles, values, and expectations.
D. Wellness
2. Positivity (B. Fredrickson, 2009)
3. Wheel of Wellness (Myers, Sweeney, & Witmer, 2001)
E. Prevention
1. Primary prevention– reduces the likelihood of a person developing a mental/emotional
disorder, through education, consultation, and crisis intervention.
2. Secondary prevention– limits the negative impact of a disorder on people who have already
3. Tertiary prevention– reduces the long-term impact on people recovering from a disorder,
through relapse prevention and aftercare.
V.Conclusion: The Comprehensive Mental Health Counseling Model
A. Assumption #1 – Mental health/wellness and mental illness/pathology lie on distinct, but
interacting dimensions (Dual-Factor Model).
B. Assumption #2 – The individual must be viewed within their unique ecological context
(Ecological Theory – Bronfenbrenner).
C. Assumption #3 – The dimensions of wellness and pathology interact with and extend through
the specific levels of ecological context.
D. The Clinical Mental Health Paradigm – a coherent model emphasizing the interactions
among variables located on the three dimensions
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