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The Last Word
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By Gray Otis, PhD, LPC, CCMHC
AMHCA President, 2011–2012

As she sat across from me, “Lucy” expressed her discomfort with how I was proceeding with her counseling. She told me frankly that my approach was not working for her. During this second session, it was clear that the therapeutic alliance was toast (not working).

Those of us who are Clinical Mental Health Counselors (CMHCs) deal in futures—the potential futures of each of our clients. Many who come to seek our help feel helpless and hopeless about the outlook for their lives. They feel fearful, depressed, and anxious, and through our work together, we offer encouragement that their lives can be more enjoyable and fulfilling. You could say we are in the profession of supporting a better future for each person we work with.

But what about our future? How will we fare personally and professionally? A recent issue of Psychotherapy Networker (March/April 2012) provides a history of psychotherapy looking back over the last 30 years. Much has changed during that time. We can all be pleased that clinical mental health counseling and therapy in general have proven to be effective in helping literally millions alleviate their psychological disorders. Our outcome effective rates range between 66 percent and 75 percent and are on par with the outcome efficacy of medical procedures such as surgery. 

Despite this, however, as a profession we still have a long way to go. The focus on “evidence-based research” has not yielded statistically significant improvements in treatment outcomes. Researchers such as Scott Miller, PhD, (AMHCA’s keynote speaker at our San Francisco Annual Conference in 2011) believe that psychotherapists, including CMHCs, will have to become even more professionally effective for their clients. We need to systematically improve our skills of empathic engagement, authenticity, and interpersonal connection to significantly improve client treatment outcomes.

So far, two of the most promising means for achieving excellence have been the statistical data collection of therapeutic alliance feedback (e.g. Session Rating Scale, etc.) and client progress assessment (e.g. Outcome Rating Scale, OQ45, etc.). By spotting alliance problems and clients’ lack of progress early, we can become more attuned to each client, avoid presumptive conjectures, and provide sound interactive interventions tailored for the individual’s needs. CMHCs with these skills achieve improved outcomes.

This was again brought home to me in working with Lucy. Her honesty about the unproductive approach I was using brought into question whether I was the right counselor for her. At that point, we paused to discuss how Lucy was feeling about the approach and about me. She told me she felt uncomfortable about “being put on the spot” and also did not believe she could meet my expectations. Her comments provided many clues for how we should proceed. After discussing a number of options, we began to explore how to collaborate more successfully. As a partner in her counseling, she became more comfortable and encouraged. Only then could real progress be made.

As CMHCs, our professional identity has never been stronger. New graduates and those of us who have been in practice for years are better prepared to meet the increasing public demands for effective treatment outcomes. Our professional identity includes:

  • The AMHCA Code of Ethics addresses CMHC-specific issues.
  • AMHCA’s Standards for the Professional Practice of Clinical Mental Health Counseling, points the way to distinguishing our profession in the field of mental health. Gaining greater education in neuroscience, clinical assessment and diagnosis, substance use and co-occurring disorders, and the treatment of trauma, as noted in our AMHCA’s Standards, will further establish our identity and our commitment to outcome excellence.
  • The AMHCA Diplomate and Clinical Mental Health Specialist (DCMHS) credential will add to the credibility of CMHCs and our profession.

Our focus on health and wellness reinforces a professional identity that we all can subscribe to and be proud of.

Another major development has been highlighted by the Institute of Medicine (IOM) findings, which have now been adopted by the Department of Veterans Affairs, the Department of Defense, and TRICARE. CMHCs possess diagnostic and treatment skills now officially recognized by the federal government in treating mental health disorders. 

Finally, I believe the future of clinical mental health counseling is tied to our ability to assess ourselves individually and professionally. Self-evaluation coupled with continuous professional growth will light the way for each of us. 

For example, the research of Brené Brown, PhD, LMSW, in vulnerability, which will be explored at AMHCA’s Annual Conference this July, illuminates how we can foster both the science and the art of clinical mental health counseling. Her frank self-appraisal led to new research, added professional insights, and enriched psychotherapy applications. 

The future of our profession is in our hands. With the federal recognition of CMHCs, I believe there is no turning back. Ultimately, however, the outlook for clinical mental health counseling is up to each of us. The profession will achieve greater standing and recognition as we integrate art and science, partner with our clients in stronger alliances, and achieve higher rates of effectiveness.

We are in the enterprise of creating better futures for our clients. It only remains to be seen how we will craft the future of the profession we share.

I Close My Year as AMHCA President With Appreciation

As I hand the AMHCA president’s gavel to Karen Langer, LMHC, in July, I would like you to know of my appreciation for AMHCA.

Our Executive Director and CEO W. Mark Hamilton, PhD, regularly transforms opportunities into successful realities. He and the staff—Melissa Hobson, Jim Finley, Linda Morano, and Renee Kreithen (and consultants Katy O’Grady and Kathleen McCarthy)—tirelessly move our association forward. 

The AMHCA board—Karen; Tom Ferro, LCPC; Judie Bertenthal–Smith, LPC, ALPS; Gale Macke; Keith Mobley, PhD, LPC, ACS, NCC; Steven Tierney, EdD, CAS; Eric Oostenink, LMHC; and Camille Clay, EdD, LPC—are great resources of both inspiration and support. 

The members of AMHCA’s committees, our state chapter leaders, the Graduate Student Committee members, and many others are instrumental in creating our profession’s future.

However, in the last analysis, AMHCA is an association made up of each of our members. Thank you for being the specialists you are, in one of the most noble of collaborative endeavors: clinical mental health counseling.