the Masses
As counseling began to expand its reach to include more mental health services, many individuals sought and obtained licensure through psychology boards (Goodyear, 2000; Lawson, 2016). Over time, these boards became less amenable toward professional counselors, making it difficult for them to obtain licenses and attempting to shut down their community practices (Lawson, 2016). Although counselors were well trained and fully qualified, they were being told they could no longer serve their communities, which jeopardized client care nationwide.
Just as counselors must be careful not to idealize our leaders, we must also be careful not to villainize other professionals. Although state psychology boards were discrediting professional counselors, many individual psychologists did not agree with these actions and positions (Goodyear, 2000). For example, Joe Wittmer, the first executive director of the Council for Accreditation of Counseling and Related Educational Programs (CACREP), was one such counseling psychologist who gave up his license when he realized that his annual fees were used, in part, to stop counselors from being licensed (personal communication, February 10, 2007). Many others were also instrumental in the foundation and shaping of the counseling profession during these challenging years.
Sweeney (2012) detailed his experiences as the first chair of the ACA Committee on Licensure when state psychology boards ordered counselors to cease and desist their practices. One salient case was that of Culbreath Cook (City of Cleveland, Ohio v. Cook, 1975), an African American counselor who was arrested on a felony charge for practicing psychology without a license under a law that had been enacted only shortly before his arrest (Sweeney, 2012). The charges were dismissed after a rigorous defense, supported in part by the American Personnel and Guidance Association’s (now ACA) Committee on Licensure. Attempts to limit the practice of competent counselors affected not only these well-established professionals but also their many clients.
As the Cook case illustrates, professional and client advocacy intertwine; advocating for the right to competently serve the public is a social justice issue that affects our communities. Sweeney (2012) defined professional advocacy as the “knowledge, skills, and competencies that advance the profession through deliberate, thoughtful actions that inform and influence others to support professional counselors because of the benefits their services bring to individuals, groups, and institutions” (pp. 81–82). Advocates aid our broader community by expanding the behavioral health workforce, expanding licensure opportunities for counselors, and increasing clients’ ability to be reimbursed for our services.
Behavioral health providers are in high demand and low supply. As of December 31, 2019, there were 6,117 federally designated Health Professional Shortage Areas in Mental Health, affecting more than 116 million people living in the United States (U.S. Department of Health and Human Services [US-DHHS], 2020). The nation lacks adequate numbers of school counselors to meet the academic and socioemotional needs of students in Pre-K through 12th grade settings. Despite a recommended ratio of 250 students to 1 counselor, the current ratio is 464 to 1 (Education Trust, 2019), with approximately 8 million students lacking access to a school counselor at all. The Education Trust noted that this shortfall is affecting ethnic minority students to a greater extent than others because school counselors who predominantly serve these groups have disproportionally higher caseloads of students. The influence of school counselors on a student’s decision to seek postsecondary education is greater among Black youth (Cholewa et al., 2015), and this shortfall may have consequences for them that extend well into adulthood.
Throughout the past 50 years, professional counselors have advocated by informing legislators and the general public of the capabilities of counselors and by creating organizational structures and standards to guide competent training and practices. School counseling led the pathway to professionalization in the 1920s, when New York became the first state to adopt certification requirements (Wright, 2012). Professional advocacy efforts grew through collaboration of the Association for Counselor Education and Supervision (ACES) with the American School Counselor Association (ASCA) as they developed training standards for school counseling programs. By the 1960s, certification was required in all 50 states (Foxx et al., 2017).
For professional counselors specializing in clinical mental health care, nationwide licensure would take much longer. As the counseling profession continued to evolve, training standards became more important and would support advocacy efforts for state licensure. Stripling (1978), and later Lawson (2016), noted how licensure and certification depend on accreditation standards that establish the measures and evaluations of counselor preparation. Accrediting bodies carefully review the quality and consistency of training, whereas licensing boards often have limited resources and purview and commonly review academic preparation only through applicant transcripts.
Although the American Personnel and Guidance Association was founded in 1952 (ACA, n.d.), it was not until 1981 that the first accrediting body, CACREP, was created to uphold training standards in counselor education (CACREP, n.d.). After years of lobbying and grassroots advocacy, in 2009, California was the last state to establish professional counselor licensure (Lawson, 2016). At that time, professional recognition was finally complete, or so it seemed.
Despite the success of licensure, professional counselors still could not participate in federally supported programs, such as those operating in the Department of Defense, due to a lack of alignment between state licensure laws and national accreditation standards (Lawson et al., 2017). To circumvent this limitation, programs such as TRICARE, the Army Substance Abuse Program, and the U.S. Department of Veterans Affairs (VA) have adopted standards that require any licensed professional counselor working independently to have graduated from a CACREP-accredited program (TRICARE, 2014; Lawson et al. 2017). Clinical mental health counselors can now become TRICARE Certified Mental Health Counselors, allowing them to serve active military personnel and their families (Hyatt-Burkart & Lopez Levers, 2020). ACA continues to maintain advocacy efforts for employment within the VA, providing information about how to enter these settings because individual and systemic barriers may impede access (e.g., Pollack, 2019). Even with licensure in all 50 states, not all counselors have permission to serve those in need.
Private health care expansion through the Patient Protection and Affordable Care Act of 2010 has also increased opportunities for counselors to serve the public. This law was designed to expand access and quality care through improved coverage, integrated services, and reduced costs with provisions that prohibited health plans from discriminating against behavioral health care professionals by their type of licensure (Sweeney, 2012). Medicaid and Medicare expansion are the current focus of professional counselor advocates, and pending legislation is moving through both the House and Senate. These examples illuminate how professional and client advocacy remain a major concern for the counseling profession and its emerging leaders.
Counselor Leadership and Advocacy Today
Building on our profession’s history of effective advocacy for clients and the right of professional counselors to serve students and clients in the community, counseling advocates continue to press for important changes across all levels (individual, community, systemwide) and settings. Many of these efforts occur daily on behalf of an individual student or client as counselors work with individuals to navigate the barriers that impede their growth and wellness. Other efforts may require more extensive leadership skills that address systemic concerns, which is evidenced through the lives of courageous and determined counselors who put service before individual rewards and conveniences.
Our hope is that you, like the leaders profiled in this book, will identify the needs of today and step forward with a servant leadership approach (Greenleaf, 1970; Lewis, 2012) that makes a difference in our profession and in the world. As an initial guide for your journey, we offer some practical strategies rooted in Trusty and Brown’s (2005) advocacy model, and we identify ongoing challenges in schools and institutions of higher education, clinical mental health settings, and in counselor education.
Practical Strategies for Invoking Change
Having discussed the “why” of leadership