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.