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Chapter Seven: The Practice of Mental Health Counseling
Chapter Overview
As students prepare to enter into the world of professional counseling, it is imperative
that they have realistic expectations about the different specializations. When asked, “What do
mental health counselors do?” many students frequently respond with things such as counseling
individuals and diagnosing and treating mental illness. There is nothing wrong with these
answers; however, these answers lack the richness of the profession.
The purpose of chapter seven serves to inform students about the various settings and
responsibilities involved in mental health counseling. It focuses on several roles that help to
further educate and inform the students of the possibilities that lie ahead for them as professional
mental health counselors.
The five primary stages of the people-helping process present a major part of the
discussion in chapter seven. Each stage is discussed and students learn what all is entailed in
establishing a relationship, assessing or defining the presenting problem, identifying and setting
contemporary trend supported the provision of a least restrictive treatment as well as offering
evidenced-based treatments. These changes have led to consumers being increasingly influential
in the development and delivery of services and are titled the “recovery and consumer
movement.” Ten fundamental components of recovery philosophy are outlined. The chapter
concludes by stating that what distinguishes a mental health counselor are the approaches,
theories, and skills applied to the client in context. Key variables from chapter 1 are reiterated.
The subsequent chapter will discuss the specific settings where services are delivered.
Learning Objectives
By the end of this chapter, students should be able to:
• Know and understand the components of the five primary stages of the people-helping
process
• Know the organizational structure and application of the ICD-10 for the diagnosis of
mental disorders
• Describe and explain a goal statement and its components
• Identify and explain modalities of intervention for mental health counselors
Key Words/Terms
• Advocacy- an indirect approach to helping clients in which mental health counselors
engage in the process of “arguing or pleading a cause or proposal”
• Autonomy- the client’s capacity and right to self-direct and be an informed consumer of
the service
• Booster sessions- one or more follow-up sessions that may occur to soften the finality of
termination
• Consultation- a helping process in which a specialized professional (the consultant), such
as a mental health counselor, assists another party (the consultee) in carrying out work- or
role-related activities within the client system
• Evidenced-based treatments: programs and interventions that have been shown through
research and program evaluation to be effective in treating and/or preventing mental
health problems.
• Evocation- the use of the client’s inherent resources, strengths, and intrinsic motivation
for change
• Family counseling-assumes that the family is the most basic emotional unit and is,
therefore, the most appropriate target for intervention
• Functional diagnosis- a current picture of the manner in which the client is navigating in
his or her niche
• Peer support specialist: consumers in recovery with special abilities acquired through
personal experience who offer service to peers and act as liaisons in agencies between
consumers and mental health professionals
• Professional advocacy- advocacy on behalf of the profession itself
• Psychoeducational groups- group experiences intentionally structured to teach
knowledge and skills for the wellness and prevention of relational, psychological, and
educational problems
• Psychotherapy groups- the application of group processes and techniques for the
treatment of psychological disturbance
• Quiet revolution- trend of mental health consumers helping themselves as advocates
Lecture Outline for Chapter Seven
Employment Settings: Where Mental Health and Community Counselors Work and What They
Do
I. Application of the Clinical Mental Health Counseling Paradigm
A. Contemporary Trends
1.The move of the primary locus of client issues from the individual to an
3. An increased integration of research findings from multidisciplinary
sources into contemporary theory and techniques in counseling
5. The integration of sophisticated technology in research and appraisal
7.Increased acceptance of multiple and subjective realities rather than
empirically based objectively defined truth
8.Increased reliance on education and prevention with a decreased emphasis
on remediation
II. Stages of Helping
A. Five Primary Stages of Helping
1. Establishing a Relationship
a. Positive, relational bond developed, characterized by personal
warmth, empathy, and acceptance
b. Establishes a mutual commitment to a collaborative process and
goals of counseling
c. Motivational Interviewing- an evidence-based approach that assists
the counselor in establishing a supportive counseling relationship
i. Collaboration- the valuing of an egalitarian relationship
2. Assessing or Defining the Presenting Problem
a. Two primary tasks to doing assessment: information gathering and
decision making
b. The Initial Interview and Assessment
i. Functional diagnosis- a current picture of the manner in
which the client is navigating his or her niche
ii. Seek to gather the following information
2) Presenting problems
4) Client’s biopsychosocial history
6) Behavioral observations
iii. Data then organized into client’s story
2) Use DSMV to make diagnosis with
dimensional approach
4) Client viewed holistically
3. Identifying and Setting Goals
a. Goal statements are products of the assessment data
i. Who
b. Enables client and counselor to identify the specific therapeutic
activities that will be most helpful and efficient in attainment of the
client’s goals
4.Planning and Introducing Termination and Follow-Up
a. Termination of counseling relationship needs to be managed with
5.Choosing and Initiating interventions
a. Therapeutic Contract- an agreement between counselor and client
formed by the concise statement of presenting problem and
diagnosis, identified goals, and selected strategies
i. Provides the roadmap for client, showing where they
b. Modalities of Intervention
i. Individual Counseling
ii. Group Work
1) Task- or work-related groups
3) Group counseling
5) Family counseling
7) Advocacy
a) Case Advocacy
III. Contemporary Trends in Community Mental Health
A. The Postdeinstitutionalization Era
1. Mentally ill increasingly vulnerable
2. Requires creative approaches to deliver service
B. Least Restrictive Treatment
1. Definition: matching the prescribed treatment’s level of intensity to the
2. Wraparound Philosophy: the use of culturally competent, community-
based supports and services to assist persons with severe mental illness as
C. Evidence-Based Treatments
1. Definition: specific programs and interventions that have been shown
2. Mandates to offer evidence-based treatments
4. National Registry of Evidenced-Based Programs and Practices (NREPP):
D. Recovery and the Consumer Movement
1. Consumers increasingly influential in shaping mental health policies and
delivering services
2. Dix, Packard, and Beers: raised consciousness of deplorable conditions of
mental hospitals
3. Main assumption: persons with shared experiences can be more helpful
and provide more supportive environments
4. Self-help/Consumer groups:
a. Alcoholics Anonymous (AA), Parents Without Partners (PWP),
5. Self-help/Consumer groups: avenue of advocacy to improve standards of
professional practice and care
6. Recovery Perspective
a. Recovery: a journey of healing and transformation enabling a
person with a mental health problem to live a meaningful life in a
community of his or her choice while striving to achieve his or her
full potential
b. 10 fundamental components of Recovery Philosophy:
i. Self-Direction
ii. Person-Centered
iii. Empowerment
7. Peer support specialist: consumers in recovery who offer service to peers
in mental health treatment; after-hour helplines and drop-in centers
IV. Conclusion
A. Clinical Mental Health Counselors are distinguished by approaches, theories, and
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