Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.”
— Consensus definition of counseling developed and approved through
20/20: A Vision for the Future of Counseling
Renaldo sits at home dreading when the next panic attack will hit him. It has happened twice this month already since his wife abandoned him and their young son. Renaldo now makes it a point to leave work earlier than normal each day to avoid the stress of traffic.
Even though Renaldo feels like he is losing control, he makes an effort to seek help for himself and his child. But while researching online, speaking to family members and his physician, and having parent-teacher conferences, he is bombarded with an avalanche of confusing and often conflicting information.
Renaldo’s family doctor recommends that he seek a psychiatrist for medication for extreme anxiety. His sister offers the phone number of a social worker Renaldo can speak to on a daily basis for a reduced fee. Online, Renaldo finds a listing for a licensed professional counselor in a neighboring city who specializes in working with panic attacks, but another website states that he should see a clinical psychologist if he is prescribed any medication. During a recent parent-teacher conference, the second-grade teacher suggested that his son meet daily with the school counselor to address his withdrawn behavior that is steadily getting worse.
Renaldo is presented with many different options, but he desires more support because he is overwhelmed and confused about which direction to follow. Should he seek medication to feel less worried? What is the difference between a clinical psychologist and a licensed professional counselor? Which one is covered by his insurance? Can he receive the help he needs through a social worker? In what ways can a school counselor support his child? Will Renaldo need to seek outside help if his son continues to struggle at school?
These are just some of the questions that Renaldo faces as he begins the seemingly daunting task of seeking mental health services. Professional counselors and counselors-in-training have found themselves facing similar questions while debating the future of our profession.
Over the past couple of decades, we have heard numerous calls for professional advocacy and a desire for unity among counseling specialties. Delegates to the 20/20 initiative, co-sponsored by the American Counseling Association and the American Association of State Licensing Boards, began meeting in 2006 as a means to position the counseling profession for the future by the year 2020. Through this initiative, delegates representing 31 major counseling organizations identified the Principles for Unifying and Strengthening the Profession, developed a consensus definition for counseling and most recently finalized a licensure title and scope of practice for counselors to lay the groundwork for licensure portability.
Although the profession has advanced the process to understand what it means to be a professional counselor, roadblocks still remain. Fragmentation continues to drive some specialties to advocate for individual areas rather than counseling as a greater whole. A lack of consensus on licensure education requirements still remains an obstacle to training.
There is also a lack of knowledge regarding public perception of our field. A consensus definition of counseling was created for use with the public, but how do we begin to explore its potential? How do we bolster our identity with the people we serve? If it can be difficult to explain to the public where our profession fits in with other mental health professionals, then how do we let the pubic know that we are available to serve their needs? How can clients such as Renaldo make better “informed decisions” about where (and from whom) to seek services?
To address these issues, the 20/20 initiative states that one of the strategies to support a unified vision of counseling includes conducting ongoing outreach to the public. By looking at the public’s perceptions of counselors and other mental health professionals, the authors of this article hoped to gain a better understanding of:
- How the public makes decisions regarding seeking mental health services
- How counselors are viewed differently from other helping professionals
- To what level the public agrees with the consensus definition of professional counseling
What is professional advocacy?
Much of the counseling literature on advocacy focuses on advocating for our clients to promote their needs and find them resources. Professional advocacy, on the other hand, has received less discussion, even though it is equally important in meeting the needs of clients and society.
Professional advocacy means promoting counseling — and counselors — as a legitimate profession that is worthy of serving the public based on specific training and credentials. Without this advocacy and recognition from the public, counselors would not be allowed to bill for insurance, gain licensure or work in a variety of settings and with a broad range of clients and issues.
Many barriers to professional advocacy exist for individual counselors attempting to balance the multiple roles of being a counselor in the community. Specific obstacles include a lack of funding or support from their agencies, a lack of time, opposition by other providers and a lack of knowledge about professional advocacy. Despite these barriers, most counselors would agree that professional advocacy is necessary to promote our services and help a greater number of clients in the community.
Counselors do not necessarily need to devote countless hours to volunteering for larger organizations or lobbying for the profession (although these efforts are still needed and helpful). Advocacy can be done at a microlevel by adjusting how you promote the counseling profession in common interactions with clients, agencies, community stakeholders and other mental health providers. But to understand how better to advocate, we must first be aware of what the public knows about professional counseling.
What does the public know about professional counseling? It turns out not a lot, at least in comparison with their knowledge of psychiatry, psychology and social work.
In 2014, we conducted an online survey of 300 individuals from the general public about their perceptions of professional counseling and other mental health professions. The participants came from 43 different states, and more than half of them had received mental health services in the past. Compared with their knowledge and perceptions of psychiatry, psychology and social work, these participants’ responses indicated less knowledge and information about the educational requirements, licensure standards, experience and scope of practice of counselors.
Their answers shed light on ways that counselors can advocate for the profession with clients and the community. What follows are important findings from our survey and suggestions for how counselors can use this information to promote their work.
Many counselors have had the experience of trying to explain what being a “counselor” really means to others outside of the profession. Often, people will follow that explanation up with a question: “So, is that like a psychologist (life coach/guidance counselor/social worker)?”
The reality is that the meaning of professional counselor is not as widely known as other mental health professions with longer histories. Given that professional counseling is relatively new compared with psychology, psychiatry and social work, the general public is not as well informed about who counselors are and what we do. In addition, the term counseling is not a protected term, meaning it is used to describe a variety of other services and professionals outside of professional counseling.
Licensure terms (e.g., licensed professional counselor, licensed mental health counselor) also vary between states, which can further confuse public understanding. Likewise, roles among professional counselors can also vary. For instance, clinical mental health counselors, university counselors and school counselors can be expected to perform different tasks for the populations they serve.
Responses to our survey regarding public perception of the educational and licensure requirements of professional counselors varied widely. Two examples: “Someone who went to college and obtained at least a bachelor’s in social work or counseling”; “A trained professional in the field of mental health and/or social services.”
Counselors can engage in professional advocacy by informing clients, students, colleagues and the public of their educational backgrounds, credentials and licenses, as well as what these things mean. Participants in our survey endorsed licensure, experience and graduate degree as the three qualities they would most value in mental health professionals.
Counselors might consider displaying their degrees, licenses and professional organization memberships in their office settings and also including this information in their professional disclosure statements. This may seem like a small step, but by taking the time to explain your training and experience, you are educating clients (and potential clients) such as Renaldo about the profession of counseling as separate from other “helping” professions and promoting your own professional competence.
Scope of practice
In general, survey participants assumed that counselors work more with individuals experiencing transient issues or problems in living, whereas they perceived psychologists and psychiatrists as working with more serious issues and social workers engaging more frequently with families. For example, one participant said, “A psychologist would be trying to understand why a person is doing something. A counselor would probably just be giving advice on how to change behavior.”
In reality, counselors work with a large range of issues, populations and techniques. However, states often regulate counselors’ scope of practice, such as diagnosing, which can cause further confusion among the general public. Providing clients, students, referral sources and colleagues outside of counseling with information about your scope of practice, areas of specialization and professional experiences could result in more accurate understanding of what you do as a professional counselor.
Returning to Renaldo’s dilemma, for example, knowing how we stand out among other helping professionals can empower us to better understand our strengths and limitations. This would allow Renaldo to get a glimpse of our professional capacity and how we might collaborate with other stakeholders to provide adequate care for him and his son.
Promoting our focus
What makes the counseling profession unique among other mental health professions is our wellness-based, developmental approach to mental health. Of all the different areas of focus for counseling, survey participants endorsed prevention as the most valued. In addition, 86 percent of survey participants agreed that the 20/20 consensus definition of counseling fit their idea of professional counseling. Counselors could promote this definition and discuss how their practices align with these beliefs as a means of providing clients with a more accurate understanding of counseling and fighting the stigma associated with seeking counseling.
For instance, Renaldo could be worried about any stigma that might result from his son seeking help from a school counselor. Reaching out to Renaldo could provide a clearer picture of the academic, career and personal focuses of school counseling services. This in turn may
help alleviate some of the anxiety he might be experiencing.
In reaction to the definition of professional counseling, one survey participant wrote, “Honestly, I didn’t realize that professional counseling was an option. I thought it was psychology or something that sounds desperate, like a life coach. It sounds useful, and like something I could recommend for friends.”
Informing the public and potential clients about the focus of professional counselors could open doors for people who would not normally seek services because of their preconceived notions of the field and mental health in general.
The two places survey participants said they were most likely to seek information about mental health services were primary care physicians and the internet. Counselors can advocate for the profession by collaborating with and educating important stakeholders and referral sources about professional counseling services.
Primary care physicians are often clients’ first stop in addressing mental health concerns, and these individuals may be more likely to follow up with a mental health referral if it comes from a trusted professional. Counselors could gain a valuable referral source by making this connection and also educate other health professionals about the research that supports the benefits of counseling for overall mental and physical health (for example, research has shown that a combination of medication and counseling can increase treatment outcomes).
The impact of this referral was evident when Renaldo’s family doctor recommended that he connect with a psychiatrist to receive medication to reduce his anxiety and address the panic attacks he was experiencing. If this doctor had been made aware of the potential benefit of professional counseling in conjunction with seeking medication, we might have been able to centralize the information Renaldo was seeking at a familiar and trusted location.
When discussing the quality and availability of counseling, survey participants frequently mentioned the relationship between counselor and client. For example, one participant stated, “I feel counseling is helpful if one finds the right counselor, and that’s not always easy. If a person finds the right counselor, therapy can literally change their life.”
Participants seemed to agree that the counseling relationship was central to the quality of their experiences with counselors. This parallels what most counselors believe and what the research shows is most important. Professional counselors could advocate for themselves and the profession by making the relationship a high priority in professional statements and behaviors.
For example, counselors in private practice settings could allow potential clients a no-obligation consultation before beginning counseling to see if the relationships might be a good “fit.” This type of approach might empower Renaldo to decide what would work best for his family and show him that he is in control of his treatment. Counselors in other settings could discuss the importance of the client-counselor relationship upfront with new clients or students and allow them to switch to a new counselor within the same setting if the client so chooses.
For many people, the decision to seek help can be difficult. Promoting the importance of relationship within counseling can help create an environment of respect, collaboration and autonomy.
Finally, counselors could advocate for the profession by reaching out to their communities outside of the counseling setting. For example, counselors could volunteer at nonprofit organizations in their local areas. This allows counselors to be a part of missions that are important to them while also helping counselors with networking and exposure. Giving the public opportunities to meet and engage with counselors outside of the traditional counseling setting and informing them about what counselors do might open doors for people such as Renaldo who have never considered counseling before.
Providing outreach in places that may need additional education or resources could also be a way to combat stigma and stereotypes of mental health issues, teach people about wellness and inform others about the benefits of counseling. For example, a counselor who specializes in children and adolescents could teach a parenting workshop for new foster parents, or a counselor who specializes in addiction could educate staff at a homeless coalition about substance abuse. Outreach and volunteer work allows counselors to use their skills in new and helpful ways, while providing the public with an experience of what counselors do and what they value.
The counseling profession and professional organizations have worked hard to advocate for counseling’s place among the other mental health professions. These efforts have resulted in advances in counselor licensure, insurance recognition and a broader scope of practice. And more advances are currently in progress.
For our profession to address obstacles such as fragmentation of counseling specialties and the general lack of public knowledge regarding our professional capacity, it is important that we develop meaningful strategies like the ones mentioned in this article to continue our efforts in professional advocacy. This can begin at the individual level by exploring our professional identity and creating individual initiatives to help people such as Renaldo better understand our profession and make more informed decisions about mental health services.
Note: Those interested in more information about this topic can refer to the article “What Does the Public Know About Professional Counseling? A Study of Public Knowledge and Perception of Professional Counselors” in the Journal of Counselor Leadership and Advocacy, Volume 3, Issue 2.
Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.
Bailey P. MacLeod is a licensed professional counselor associate and counselor educator in Charlotte, North Carolina, where she specializes in clinical mental health and addiction. Contact her at firstname.lastname@example.org.
James W. McMullen is an assistant professor of school counseling at the University of Wisconsin-Stout. He is a licensed professional counselor associate, national certified counselor and licensed school counselor. Contact him at email@example.com.
Letters to the editor: firstname.lastname@example.org
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.