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Clinical Mental Health Counseling

Clinical Mental Health Counseling
Elements of Effective Practice

Edited by:

August 2016 | 480 pages | SAGE Publications, Inc
Referencing the 2016 CACREP standards, Clinical Mental Health Counseling: Elements of Effective Practice combines solid foundational information with practical application for a realistic introduction to work in community mental health settings. Top experts in the field cover emerging models for clinical interventions as they explore cutting-edge approaches to CMH counseling. With case studies integrated throughout, students will be well prepared to move into practicum and internship courses as well as field-based settings.

“An instant classic. Young and Cashwell have assembled a stellar group of counselor education authors and produced an outstanding, comprehensive, and easy-to-read text that clearly articulates and elevates the discipline of clinical mental health counseling. This book covers everything a CMHC needs to hit the ground running in clinical practice!"

Bradley T. Erford, Loyola University Maryland, Past President of the American Counseling Association

About the Editors and Contributors
Kerrie K. Fuenfhausen, Scott Young, Craig Cashwell, and Muthoni Musangali
1 History and Evolution of Clinical Mental Health Counseling
Foundational Principles of Counseling

Wellness Model of Mental Health

Developmental Perspective

Prevention and Early Intervention


Multicultural Worldview

History of CMH Counseling

Historical Influences

Professional Practice in CMH Counseling

Professional Identity


Models of Change

Roles and Functions of CMH Counselors

CMH Counselor Functions

CMH Counselor Roles

Populations Served

Case Study


Jamie Crockett
2 Legal and Ethical Issues 31
What Is Professional Conduct?

Consult, Consult, Consult!

Moral Principles

Professional Standards for Ethical Practice

Legal Considerations

Legal and Ethical Challenges

Ethical Decision Making

Multicultural and Social Justice Considerations

Case Studies

Select Resources for Ethical and Legal CMH Counseling Practice


Catherine Y. Chang, Simone Lambert, and Emily Goodman-Scott
3 Advocacy and Social Justice
The Case of Yolanda

Ecological View

Case Study Discussion

Understanding Advocacy and Social Justice

Case Study

Multicultural Competence and Culturally Responsive CMH Counseling

Case Study Discussion

Social Injustice and Mental Health

Privilege and Oppression



Racism and Sexism


Case Study Discussion


Case Study Discussion

Advocacy and Social Justice Counseling

Client Advocacy

Case Study Discussion

Professional Advocacy

Case Study Discussion

Global Perspectives on Counseling



Amy Banner
4 Continuum of Care
Continuum of Care: One Size Does Not Fit All

Modalities of the CMH Counseling Continuum of Care

Individual Counseling

Group Counseling

Couple and Family Counseling

History of the CMH Counseling Continuum of Care

Ethical and Developmental Aspects of the CMH Counseling Continuum of Care

Services, Settings, and Roles Across the CMH Counseling Continuum of Care

Prevention and Education Services

Outpatient Services

In-Home Services

Partial Hospitalization Programs (PHPs) and Intensive Outpatient (IOP) Services

Inpatient Services

Residential Services


Crisis and Emergency Services

Professional Issues Affecting the CMH Counseling Continuum of Care

Case Study


Casey Barrio-Minton
5 Assessing Client Concerns
Assessment Foundations

Purposes and Methods of Assessment

Clinical, Intake, and Diagnostic Interviewing

Types of Interviews

Initial or Intake Interview

Unstandardized Questionnaires and Checklists

Mental Status Examinations

Mini–Mental State Exam

Using Standardized Tests and Inventories to Inform Counseling

Broad-Symptom Inventories

Specific-Symptom Inventories

Structured Personality Inventories

Projective Techniques

Qualitative Assessment

Collateral Sources

Screening for High-Risk Situations

General Medical Conditions

Suicide Risk

Violence Risk

Intimate Partner Violence and Abuse

Substance Concerns

Cultural Bias in Assessment

Using Assessment to Inform Counseling

Case Study


Appendix: Current Concerns Questionnaire and Checklist (Adult)

Gary Gintner
6 Diagnosis
Psychopathology and Etiology

Mental Health and Mental Illness

Dimensions of Psychopathology

Etiological Factors and the Biopsychosocial Model

Diagnostic Issues With the DSM

DSM: A Look Backward


Diagnostic Process: Four Guiding Principles

Principle 1: Check the Adequacy of Your Information

Principle 2: Use Diagnostic Hierarchies for Differential Diagnosis

Principle 3: Resolve Diagnostic Uncertainty by Examining the Usual Suspects

Principle 4: Your Diagnosis Is a Hypothesis That May Need Correcting

Case Study


Daniel M. Paredes and Maria A. Brunelli Paredes
7 Treatment Planning
Determining Client Needs and Appropriate Services

Case of Tara

From Conceptualization to Treatment Planning

Personal Style

Counselor Theoretical Framework

Expectations of the Counselor’s Work Setting

Developing and Implementing Treatment Plans

Treatment Goals

Case of Joseph and Sophia

Treatment Objectives

Treatment Interventions

Additional Treatment Plan Components

Referral, Keeping a Resource List, and Application

Keeping a Resource List


Case of Emily

Termination Versus Maintenance

Treatment Planning and Special Populations

Treatment Planning With Children and Adolescents

Treatment Planning With Mandated Clients

Case Study


Todd Lewis and John Culbreth
8 Psychiatry and Psychopharmacology
Brain Physiology, Neurotransmitters, and Medication: A Basic Overview

Mechanisms of Action

Why Use Medication in the Treatment of Mental Disorders?

Controversy in Using Medication in the Treatment of Mental Disorders

The Mental Health Counselor’s Dilemma

Classes of Psychotropic Medications, Their Effects, and Side Effects

Antidepressant Medications

Antianxiety Medications

Antipsychotic Medications

Bipolar Medications

Working Effectively With Psychiatrists

Making Medication Referrals

Medication Compliance

Assessing and Managing Side Effects

Working Effectively With Clients and Medication

Talking to Clients About Medication

Medication Advocacy

Legal and Ethical Issues With Psychopharmacology

Case Study


Laura Welfare, Paige Greason, and Keith Mobley
9 Managed Care, Billing, and Documentation
Managed Care

Managed Care Laws and Legislation

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA Privacy Rule

HIPAA Security Rule

HIPAA Enforcement

Mental Health Parity and Addiction Equity Act

Affordable Care Act

Managed Care: Becoming an Approved Provider

Insurance: Private and Public Payers

Private Insurance

Government-Sponsored Insurance

Self-Pay and Other Means

Maintaining Records

Importance of Paperwork

Administrative and Clinical Documentation Practices

Clinical Documentation Practices

Intake Assessment Forms

Screening and Outcome Measures

Clinical Case Notes


Case Study 1: Navigating Insurance Coverage

Case Study 2: Writing Eff ective Case Notes


Appendix: Personal History and Intake Form

Amber L. Pope and Allison Marsh Pow
10 Crisis Management and Disaster Relief
Differentiating Crisis Management and Disaster Relief

Crisis Management

What Is a Crisis?

Crisis Counseling

Range of Individual Crises

Principles of Crisis Management

Crisis Management Planning

Emergency and Disaster Relief

Impact of Crises and Disasters

Factors Influencing Mental Health After an Emergency or Disaster

Groups at Risk

Emergency and Disaster Response

Immediate Interventions

Intermediate and Long-Term Interventions

Disaster Mental Health Training

Impact of Crisis Counseling and Disaster Relief Work on CMH Counselors

Case Study 1: Crisis Management

Case Study 2: Disaster Mental Health


DiAnne Borders
11 The Importance of Clinical Supervision to Effective Practice
Models of Clinical Supervision

Developmental Models

Discrimination Model

Peer Models

Group Supervision Models

Triadic Supervision

Maximizing Your Supervision Experience

Practice Self-Assessment and Create Learning Goals

Prepare for Supervision

Take Risks

Practice Self-Reflection

Consider Power and Authority; Evaluation and Feedback

Practice Peer Feedback in Triadic and Group Supervision

Bring Difficult Topics to Supervision

Poor Supervision


Case Study


Gerard Lawson and Jennifer M. Cook
12 Wellness, Self-Care, and Burnout Prevention
CMH Counseling Risks and Challenges

High-Touch Hazards


What Burnout Looks Like

Burnout Prevention

Vicarious Traumatization

Symptoms and Signs of Vicarious Trauma

Addressing Vicarious Trauma

Compassion Fatigue

Compassion Fatigue Described

Contributing Factors to Compassion Fatigue

Identifying Compassion Fatigue

Counselor Wellness


Mindfulness Defined


Career-Sustaining Behaviors

Healthy Habits

Case Study


Kelly L. Wester and Tamarine Foreman
13 Using Research to Improve Clinical Practice
Research Defined and Described

Ways of Knowing

Evidence-Based Practice

Scientist-Practitioner Model

Case Study

Step 1: Assess the Client

Step 2: Create a Well-Formulated Question

Step 3: Conduct a Search for Evidence

Step 4: Select and Access Articles to Read

Step 5: Evaluate and Appraise the Quality of Research

Step 6: Synthesize Information

Step 7: Clinical Application

Step 8: Evaluation



Jane E. Myers and Laura Jones
14 The Applications of Neuroscience to Clinical Mental Health Counseling
Neuroscience in Counseling

Neural Anatomy

Neuroscience and the Therapeutic Relationship

Therapeutic Process and Neuroplasticity

Neurofeedback: One Application of Neuroscience in Practice

What Is Neurofeedback and How Does It Work?

Case Study



Amanda L. Giordano, Philip B. Clarke, Cheryl L. Fulton, and Tammy H. Cashwell
15 Emerging Approaches to Clinical Mental Health Counseling
Motivational Interviewing

The Basics of MI

Support for MI

MI in Practice

Case Study

Emotionally Focused Couple Therapy

The Basics of EFT

Stage 1: Deescalation of Negative Cycles of Interaction

Stage 2: Changing Interactional Positions

Stage 3: Consolidation and Integration

Support for EFT

EFT in Practice

Case Study

Dialectical Behavior Therapy

The Basics of DBT

Support for DBT

DBT in Practice

Case Study

Interpersonal Psychotherapy

The Basics of IPT

Support for IPT

IPT in Practice

Case Study

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

The Basics of TF-CBT

Support for TF-CBT

TF-CBT in Practice

Case Study


The Basics of Mindfulness

Support for Mindfulness

Mindfulness in Practice

Case Study

Acceptance and Commitment Therapy

The Basics of ACT

Support for ACT

ACT in Practice

Case Study

Spirituality in Counseling

The Basics of Spirituality in Counseling

Support for Spirituality in Counseling

Spirituality in Counseling in Practice

Case Study




“Having gathered a plethora of established experts in the field of mental health counseling, the editors packed this book with content that will meet or exceed the curricular needs of any graduate counseling course; ‘comprehensive’ is an understatement!”

W. Bryce Hagedorn
University of Central Florida

“An instant classic. Young and Cashwell have assembled a stellar group of counselor education authors and produced an outstanding, comprehensive, and easy-to-read text that clearly articulates and elevates the discipline of clinical mental health counseling. This book covers everything a CMHC needs to hit the ground running in clinical practice!”

Bradley T. Erford
Loyola University Maryland, Past President of the American Counseling Association

“A ‘must-have’ resource for anyone looking for a comprehensive and reader-friendly clinical mental health counseling text! The introductory chapter provides a solid context for the ensuing chapters that focus on specific topics (such as legal/ethical issues, diagnosis, supervision), all authored by leading experts. It’s all here—everything that learners need to know as they embark on their professional journeys to becoming CMHCs.”

Barbara Herlihy
University of New Orleans

Clinical Mental Health Counseling: Elements of Effective Practice is a great text for introducing students to the roles and functions of clinical mental health counseling. The authors have organized the material in a clear and engaging level which makes it appropriate for students. I particularly appreciate the documentation and evidence-based sections.”

Alfonzo Haralson
Jackson State University

“The authors have succeeded in building a very comprehensive book, focused on the CACREP standards, that is up to date and gives new and also practical information regarding the profession.  There are some chapters that are very unique for an introductory textbook (e.g., chapters devoted to billing, documentation, psychopharmacology, neuroscience, a full chapter on research). There is also some cutting-edge information included on evidence based practices. Usually, there isn’t an entire chapter devoted to advocacy. Thus, instructors have to supplement the information in textbooks with the ACA Advocacy Competencies and various articles and examples. The chapter on advocacy is a treasure because it is comprehensive and really introduces the students to the counselor advocacy role up front!”

Heather Trepal
University of Texas at San Antonio

“The authors were able to invite contributors that are known experts in their field. They write from a strong theoretical base and are practitioners in their areas of expertise.”

Judith G. Miranti
Xavier University of Louisiana

“This book provides the most comprehensive knowledge, skills, and applications about mental health practice in community settings.” 

Kananur V. Chandras
The Fort Valley State University

“By offering a text that can provide a thorough foundation for counselor trainees, Young & Cashwell have offered Counselor Educators a much-needed tool for bridging a significant gap in counselor training.”

Kathleen Woods
Chadron State College

Clinical Mental Health Counseling: Elements of Effective Practice is current, thorough, and student friendly.”

Lakitta Johnson
Jackson State University

Clinical Mental Health Counseling: Elements of Effective Practice is a comprehensive overview of a complex topic.”

Robert C. Schwartz
University of Akron
Key features
  • Required 2016 CACREP standards for CMH Counseling programs are covered.
  • Chapter authors are leading counseling writers, and many are practicing CMH counselors.
  • Chapter topics apply theory to real-world issues of practice, such as paperwork and medications.
  • Case studies and discussion questions afford students opportunities to apply what they read to practical situations.
  • Evidence-based treatments, neuroscience, and other cutting-edge topics reflect the currency of the text.Bolded key concepts help students to focus their reading and learning.

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