Advocacy is key for the clinical mental health counseling profession. Clinical mental health counselor advocates (CMHCAs) rely on the advocacy competencies to guide their assistance to clients in removing barriers and to secure deserving resources, or to advocate on behalf of clients, groups, or communities. This chapter addresses the importance of advocacy and social justice advocacy, and the strategic positionality of the clinical mental health counselor as an advocate for addressing social and institutional barriers that reduce client access, equity, and success. It identifies the advocacy competencies and approaches to advocate for clients care, and emphasizes the ways that they foster resilience and growth. Specific cases illustrate clients' and professionals' understandings of and access to a variety of community-based resources. The chapter also addresses strategies to advocate for the profession and for clinical mental health counseling professionals.

This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.

The practice of professional counseling is governed at the national and state levels by a variety of governing boards and regulatory agencies. This chapter focuses on the legal and ethical issues that are salient to clinical mental health counselors. Specifically, it discusses the American Counseling Association (ACA) Code of Ethics, the American Mental Health Counselors Association (AMHCA) Code of Ethics, state licensure and national certification, confidentiality, mandated reporting, duty to warn, and scope of practice. The chapter also focuses on the responsibility of counselors to engage in ethically based practice. In addition, the chapter connects the ACA and AMCHA ethical codes and the Council for Accreditation of Counseling and Related Educational Programs standards to several topics in ethical practice, including values clarification, bias assessment, boundary awareness and maintenance, and self-reflection. The chapter concludes with a case scenario to illustrate chapter concepts and a section on resources to provide further information.

It is important for beginning Clinical Mental Health Counseling (CMHC) students to understand that their engagement in the CMHC specialty is one part of the larger professional counseling framework. This chapter provides a historical overview of the counseling profession and its developmental trajectory, emphasizing the origins of mental health treatment and the reemergence of counseling as a wellness-based approach. It offers discussion concerning the push toward a pathogenic model of conceptualizing mental illness and the subsequent, current resurgence of a strength-based notion of care. The chapter provides an overview of the major theories of counseling as a means for understanding the development of counseling as a unique and separate field from psychology, psychiatry, and social work. It identifies the specializations within the counseling field, the range of employment opportunities and the current labor market, and how counseling is integrated within a system-of-care approach.

This chapter makes a distinction between grief counseling and grief therapy. Counseling involves helping people facilitate uncomplicated, or normal, grief toward a healthy adaptation to the tasks of mourning within a reasonable time frame. The chapter reserves the term grief therapy for those specialized techniques that are used to help people with abnormal or complicated grief reactions. The overall goal of grief counseling is to help the survivor adapt to the loss of a loved one and be able to adjust to a new reality without him or her. Whatever one’s philosophy of grief counseling and whatever the setting, there are certain principles and procedures that help make grief counseling effective. The chapter provides guidelines for the counselor so that he or she can help the client work through an acute grief situation and come to a good adaptation.

Michael is a 12-year-old Black male in the seventh grade in a remote rural farm community. He recently relocated to this community from a large metropolitan area, where he was a sixth-grader in a culturally diverse elementary school. He is the oldest of three children with parents who have become pillars in the community despite being new there. Identified as gifted in his previous elementary school, Michael took science and math classes in higher grade levels by single-subject acceleration. He had to work much harder in his language arts classes, but he loved his school and was liked by his peers and teachers.

While Michael’s new school is culturally diverse, the school and community norms for students are different. The emphasis is on community fellowship, service, and helping one’s family. Little is said about college; instead, jobs in agriculture and manufacturing are emphasized. Michael has been invited several times to participate in the 4H club. Upon arriving at his new school, despite providing his previous years’ school records, he is placed in the traditional seventh-grade classes. He complains to his parents that his math and sciences courses are a repeat of information from his previous school. Michael is also encountering difficulties in his language arts classes, which require more traditional essay-writing than his last school did.

In a six-week progress report, Michael’s teachers noted that he seems unengaged and withdrawn in class. His parents believe he has become apathetic about school, and they are worried he might lose his love of math and science. In addition, Michael’s language arts homework frequently leads to anger and frustration at home.

Michael’s parents have requested meetings with his teachers, with the school counselor, Brenda, also attending. Prior to the meeting, she evaluates Michael’s cumulative file. Based on his grades, standardized test scores, and teacher comments, she determines that he is extremely bright and very talented in math and science, but has challenges in language arts and social sciences. His teachers’ comments include “Handwriting continues to be a challenge, but he is working very hard,” “Michael is a very hard worker, but writing paragraphs or persuasive essays requires much more effort,” “He is quick at multiple-choice questions and short-answer questions are okay,” “His reading comprehension is fantastic, but writing brings out frustrations,” and “I realized Michael was much more at ease with oral book reports than written. His love of learning really shines through when he gets to talk about what he knows, in all subjects. He even manages to get his peers interested.”

Brenda makes a phone call to the school counselor at Michael’s former middle school and the elementary school he attended. She hears wonderful things about Michael, as well as about his challenges with written work. Many of his former language-arts teachers allowed Michael to demonstrate his mastery of content and skills orally or via multiple choice or computerized testing. The middle school counselor reported that he and Michael’s parents had discussed talking to their school psychologist about more testing for Michael because they were concerned about the increased requirements for writing in middle school. But that conversation did not lead to changes before the end of the school year, when Michael’s family moved.

To set the stage for what counselors need to know, this chapter introduces the reader to an overview of theories that lay a foundation for working with adult clients. It provides a discussion of theoretical perspectives that relate to both individual development and contextual factors. To capture this intersection of influence, the chapter highlights Erikson’s (1950, 1963) psychosocial stage model, along with contextual and life span perspectives of adult development. It introduces the transition perspective, delving into the transition process itself. Adults face times that are increasingly challenging. A central theme in our current social context is change, reflecting the dynamic impact of forces across demographic, social, cultural, technological, political, and historical domains. A theory is a set of abstract principles that can be used to predict facts and to organize them within a particular body of knowledge.

In a rural school district, Abby is responsible for creating and delivering gifted-education programming across all school levels. She wants to develop a comprehensive K–12 affective curriculum for it. Though the majority of students are from middle-class families, others come from families that are struggling economically due to unemployment, military deployment, parental incarceration, single parenting, and addictions. Teachers and administrators are concerned about student well-being. Bullying has been a school concern, and the community has been shocked by three student suicides among the “best and brightest” over the past 2 years. Abby believes that attention to the social and emotional development of gifted students during all school years might make a difference. She wants to collaborate with Jack, the one K–12 school counselor, in possibly cofacilitating two proactive small discussion groups of gifted students. She wants to observe his listening and responding skills and share information with him about giftedness. In the past, Jack has not thought of organizing small groups for gifted students, but agrees to the collaboration. He says they should conduct a needs assessment among students identified as gifted and organize a group of high achievers around a common concern, such as bullying or bereavement—an approach he used in the past with the general population. Abby has something different in mind, but is hesitant to advocate for her view, since group work is in Jack’s “territory.” After she learns some skills from Jack, she wants all identified students to have a small-group experience at some point. She also understands that programming should address needs of more than just high achievers, including highly intelligent academic underachievers, who currently are not viewed as eligible for it. Abby needs to have a clear rationale for both the group format and mixing achievers and underachievers in the groups before she talks with the counselor again.

Samantha has been the middle school counselor in a small rural district in the Midwest for the past 3 years. She has spent most of her time in program development and building relationships with students, parents, staff, and community partners. Currently, she is working with community and district administrators to increase access to Internet and other technology in her building for more program options; unfortunately, the district’s increasingly tight budget precludes upgrades to current systems. As the academic year comes to a close, she talks with Rachel, a veteran teacher with considerable experience in differentiation. Rachel is concerned about some of her math students. By year’s end, due to her differentiated curriculum, at least seven will have completed Algebra 1, the most advanced math class at the school. Rachel wonders what can be planned for them for next year. A few parents have expressed concerns about future classes as these students progress. She asks to meet with Samantha about this situation.

An experienced, progressive superintendent is new to a large school district, and at her first meeting with all teachers, she describes ambitious goals, one of which is to reconceptualize and reorganize the program for gifted students. She wisely does not speak negatively of the present program; instead, she explains that an administrative transition is simply an opportunity to look at existing programs. Regarding gifted education, she wants to examine current thought in the field about giftedness, what residents in the district think about those perspectives, whether criteria used for identification of eligible students in the district match the programming offered, which programming models are available, which kinds of goals might be appropriate for local programming, which community resources might supplement and enhance programming, and whether the “whole” gifted child is adequately attended to.

The district she left had experienced individual and family tragedies and disturbing student behavior in recent years involving gifted scholars, gifted athletes, gifted musicians, gifted visual artists, gifted leaders, and gifted underachievers. She says she has already begun her own personal exploration of pertinent literature, and she wants the district to be proactive and strategic regarding preventing poor outcomes for gifted and talented students—at all school levels, beginning at the elementary level. She promises to organize a task force of representative classroom teachers, school counselors, gifted-education personnel, parents, and possibly students to study pertinent literature, explore various models, and make recommendations. She encourages individuals interested in being on the task force to contact her.

Ben, a middle school counselor, immediately expresses interest. He has been frustrated with not being able to connect adequately with some gifted students who have concerns—both high and low achievers. He was always a high achiever himself, but he has realized that gifted students are highly idiosyncratic, with many not fitting common stereotypes. He wants to understand them better and help them understand themselves better as well. He is glad the superintendent seems interested in their well-being, not just their academic performance.

Ben suspects there are many counseling needs in this population, but he has never heard a local or state counseling peer refer to these needs at professional meetings. He also has wondered about the identification process and the fit of his most complicated gifted counselees with the current programming. In fact, he has met with brilliant thinkers who have not been deemed eligible and assumes that learning disabilities affect the test scores used for screening. Last, since he has worked with a number of referred gifted underachievers, he has wondered which kind of program would engage them in school and academics—and even whether academic achievement should be the sole goal.

Ben believes that being on the task force, if he is selected, will be informative and helpful as he considers how to be more effective with this special population. In fact, he is selected. The superintendent is wise to include a counselor on the task force.