Critical Advances in Clinical Mental Health Counseling Over the Last Decade

During the past decade, some important achievements have been made that greatly benefit the work of clinical mental health counselors. These include the establishment of counseling licensure in all 50 states; the approval of mental health counselors for employment by the Veterans Administration; the acceptance of mental health counselors for reimbursement by TRICARE, the insurance provider for the U.S. Military; the expanded recognition of the Council for Accreditation of Counseling and Related Educational Programs (CACREP) as the gold standard for counselor training for licensure; increased use of technology in counselor training and practice; and the introduction of a national “portability” model for recognizing counselor licensure between different states across the country.

In 2009, then-Governor Arnold Schwarzenegger signed a bill into law making California the 50th and final state in the nation to license mental health counselors.¹ In just 33 years, counseling licensure expanded from only one state (Virginia, which began the practice in 1976) to nationwide adoption. Thanks to the successful advocacy work of many leaders in the counseling profession, clinical mental health counselors in all states can now practice independently as licensed professionals. The achievement of licensure in all 50 states also signifies recognition on a fully national level of the important role that professional counselors play in meeting the nation’s mental health needs.

In 2010, the Department of Veterans Affairs (the VA) formally recognized mental health counselors as mental health specialists within the Veterans Health Administration.² This was a landmark step for the counseling profession, and for mental health counselors in particular, as it meant that licensed mental health counselors could assume positions of employment with the VA that had previously only been available to licensed clinical social workers. More importantly, it added mental health counselors to the list of recognized mental health service providers available to satisfy the large unmet needs of our nation’s veterans.

Prior to 2014, clinical mental health counselors could only be reimbursed for their services by the U.S. military’s insurance program, TRICARE, if a licensed physician signed off on their work. This meant that counselors at that time were not considered by the military to be independent mental health service providers. However, in the summer of 2014, TRICARE ruled that mental health counselors were eligible to be certified under TRICARE to receive military insurance reimbursement for their services as independent practitioners.³ This action greatly extended the availability of counseling services to military personnel and their families and further increased the already-growing scope of employment possibilities for clinical mental health counselors.

CACREP was founded in 1981 with the mission to set minimum academic preparation standards for counselors. Originally, CACREP established separate standards for the training of community counselors and mental health counselors, but in 2009, the two separate counseling specializations were combined into the single specialization of clinical mental health counseling.⁴ Today, there are over 860 CACREP-accredited counseling programs, and the number continues to grow.

Advances over the past decade in technology-assisted communication have had a substantial impact on counselor training and practice. Whereas training to become a clinical mental health counselor previously required on-site attendance at a graduate program in counseling, students now have the option to complete their graduate degree requirements at one of over 40 CACREP-accredited online programs. By attending an online CACREP-accredited program like the Online Master of Education (M.Ed.) in Counseling from the William & Mary School of Education, students can now access the highest possible standard of counselor training no matter where across the country they may live.

New technology also now enables practicing mental health counselors to provide their services online to clients who are unable to travel to a counseling office. Although online counseling requires special provisions for protecting client confidentiality as well as licensure in each state where online counseling services are being provided, its use is expected to increase in the future as technology becomes increasingly integral to everyday life.

Since the first counseling licensure law was passed in Virginia in 1976, other states have passed their counseling licensure laws independently of one another. This individual state governance of counselor licensing has resulted in sometimes substantial differences among states in licensure requirements, which have made it difficult for practicing mental health counselors licensed in one state to transfer their license if they locate to another state.

Work continues by leaders in the counseling profession to make licenses more acceptable or “portable” from one state to another. Toward that goal, four major professional organizations in counseling worked together in 2017 to develop the National Counselor Licensure Endorsement Process (NCLEP). The NCLEP will streamline the licensure process from state to state for mental health counselors who meet basic training qualifications and have a history of successful practice for at least three years. Although its acceptance by all 50 states remains a major hurdle, the proposal of the NCLEP is an important and formal step toward the goal of licensure portability across the mental health counseling profession.

The many advances in mental health counseling over the last decade have occurred for two primary reasons. First, the willingness of members of the counseling profession to step up into leadership roles and to use those positions to advocate for needed changes has given the counseling profession a “voice” that has moved state legislatures toward recognizing mental health counselors as an important player in the American mental health services system. Key to this effort has been advocacy on the part of leaders from organizations such as the American Counseling Association, the National Board of Certified Counselors, CACREP and the American Mental Health Counselors Association.

A second and equally important reason for the strong growth and widespread recognition of mental health counseling in the past decade is the outstanding work that has been done by practicing mental health counselors during that period. Through their consistent provision of high-quality, wellness-oriented counseling services, mental health counselors have demonstrated their value and raised the public’s impression of the counseling profession to a level that was once reserved for clinical psychology and clinical social work only.

To enable these advances to continue during the next decade, the counseling profession will need its members to continue to advance into leadership positions and to uphold the high standards of practice set by those who have gone before them.

If you seek an opportunity to make a positive difference as a practitioner and leader in today’s mental healthcare system nationwide, consider how William & Mary’s Online M.Ed. in Counseling with a concentration in Clinical Mental Health Counseling could be an exciting and beneficial place to begin.