Title: Generic professional and technical knowledge, skills, and abilities needed by mental health counselors
CITATION PDF VIEWER THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00098274/00001
 Material Information
Title: Generic professional and technical knowledge, skills, and abilities needed by mental health counselors
Physical Description: x, 301 leaves : ; 28 cm.
Language: English
Creator: Corley, Dan Alan, 1950-
Copyright Date: 1981
 Subjects
Subject: Student counselors -- Training of   ( lcsh )
Competency-based education   ( lcsh )
Mental health services   ( lcsh )
Counselor Education thesis Ph. D
Dissertations, Academic -- Counselor Education -- UF
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Statement of Responsibility: by Dan Alan Corley.
Thesis: Thesis (Ph. D.)--University of Florida, 1981.
Bibliography: Bibliography: leaves 286-300.
General Note: Typescript.
General Note: Vita.
 Record Information
Bibliographic ID: UF00098274
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000294977
oclc - 07831169
notis - ABS1314

Downloads

This item has the following downloads:

genericprofessio00corl ( PDF )


Full Text













GENERIC PROFESSIONAL AND TECHNICAL KNOWLEDGE,.SKILLS,
AND ABILITIES NEEDED BY MENTAL HEALTH COUNSELORS







BY

DAN ALAN CORLEY


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY




UNIVERSITY OF FLORIDA































Copyright 1981

by

Dan Alan Corley













ACKNOWLEDGEMENTS


It is rare that a person is given an opportunity to acknowledge

the individuals who have influenced a segment of one's life. With this

opportunity, I experience my life as being so blessed with special

people that naming a few is only a token representation of the many

who have brought me joy and made my life full. I do want to identify

the following helpers who contributed to this chapter of my life:

Paul W. Fitzgerald, my chairman and friend;

R. 0. Stripling, my former chairman and mentor;

James J. Messina, for invaluable assistance in this project;

Patricia Campbell, for her assistance and secretarial service;

Robert Norman, whose bright ideas provided a creative release

for mine;

George Medzerian, who listened until I knew what I was talking

about;

Samuel Cockran, Delphi theorist and consultant;

Warren Repole, for computing expertise;

Robert Tolsma and Harris Cohen, for specialized information from

afar;

and a host of friends who provide support, encouragement, and

confidence in my abilities, particularly Cindy, Tim, Howard

and Glory, Carolyn, Paul, James and Martha, Marie, Dick and

Sandra, Ted, Wade, and Gerry and Robin.








A special kind of recognition is due my family. My parents

Paul and Jean Corley have provided a support and nurturance that spans

creativity, sensitivity, and love in my sisters, Vicki and Christi,

and me. I am particularly grateful for and to my children, Eric,

Lori, Kevin, and Kyle, for patience and help that made this time

tolerable and challenges that made me grow.

I thank God for Joyce, my wife, who in the ebb and flow of our

relationship has been my strength and my dependent for whom I was

strong. Joyce has beeh my love, my support, my partner, and my

teacher. I could expect to find no greater fulfillment that I have

with her.













TABLE OF CONTENTS


CHAPTER PAGE

ACKNOWLEDGEMENTS . . . . . . . ... iii

ABSTRACT . . . . . . . .... ..... viii

I INTRODUCTION . . . . . . . . ... .. .

Statement of the Problem . . . . . .... .
Manpower Needs and New Professions ... . ..
Credentialing and Quality Control. . . . . 4
Purpose of the Study . . . . . . . . 6
Definitions. . . . . . . . ... ... 7
Rationale. . . . . . . . . ... ... 9
Assumptions. . . . . . . . ... .. 10
Implications . . . . . . ... . 11
Organization of the Study. . . . . . ... 12

II REVIEW OF THE LITERATURE . . ... . . . .. 14

Credentialing of Mental Health Counselors. .... . 15
.Credentialing Prior to the Seventies ... .. ... 15
The Sociological Perspectives. . . . . .. 17
Influence of Third-Party Reimbursement . . .. 19
Nonprofessional Developments in Regulation . . 23
HEW Licensure Studies.. . . . . . .. 26
State Actions. .. . . . .. .. .. . 33
Recent Development in Counselor Credentialing. .. 34
Return to Definition and Standards . . ... 39
Alternatives to Licensing. . . . . ... .. 41
The Development of the Profession of Mental Health
Counselors . . . . . . . . . . 43
Early Development. . . . . . . . . .43
The Community Mental Health Movement ...... 49
Professional Identity Confusion. . ... .... . 50
The Counseling Psychologistd Dilemma ...... 53
Changes in Counselor Education . . . ... 54
Mental Health Counselors Emerge. . . ... 57
Components of Counselor Competence . . . ... 60
The Competency-Based Issue . . . . . . 61
Counselor Competency Issues. . . . . . 63
Competency Generation and System Organization. .. 66
Competency Applications in Counseling ........ 70
Competency Content- Knowledge, Skills, and
Abilities. . . . . . . . . .. 72








CHAPTER PAGE

Delphi Technique .. . . .. .. ... 77
Types of Delphi Studies. . . . . . .. 78
Methods and Goals. . . . . . . . ... 79
Delphi Uses. . . . . . . . . . 81
Delphi Advantages and Weaknesses . . . ... 83
Summary ... .. . . . . . . ... 89

III RESEARCH METHODOLOGY . . . . . . .... .91

Overview.. . . . . . . . . . .. 91
Research Question. . . . . . . . ... 91
Method . . . . . . . . . . . .. 92
Subjects . . . . . . . . ... . 92
Instrumentation. . . . . . . .. .. 92
Round I Procedures . . . . . . .... 94
Treatment of Round I Data. . . . . . ... 96
Round II Procedures. . . . . . . ... 97
Treatment of Round II Data . . . . .... .98
Round III Procedures . . . . . . . 98
Research Question Data Treatment . . . ... 99

IV RESULTS. . . . . . . . . . . . 100

The Delphi Panel . . . . . . . . 101
Panel Profile. . . . . . . . . .. 101
Response Profile . . . . ... . . 104
Statements Identified as High Priority . . .. 106
Round Comparisons . . . ...... .. .. 112

V DISCUSSION . . .. . . . ... ... . 113

Majority Report. . . . . . . . . .. 114
Preparation. .... . . . . . . .. 114
Client Services. . ............ .. 117
Support Services ............. .. 121
Minority Report. . ............... . 122

VI SUMMARY AND RECOMMENDATIONS. . . . . .... 127

Credentialing. . . . . . . . . ... 128
Professional Development . . . . . . .. 130
The Study of Knowledge, Skills, and Abilities. . 132

APPENDICES

A MESSINA SELECTION LETTER . . . . . .... 133

B MESSINA INVITATION TO PARTICIPATE LETTER . . . 135

C REPLY CARD . . . . . . . . ... . .. 137










D A COMPARISON OF SELECTED CLASSIFICATION SYSTEMS
FOR COUNSELOR COMPETENCIES . . . . . .... 138

E HIERARCHY OF DOMAINS AND MAJOR CLASSES. USED TO
IDENTIFY GENERIC KNOWLEDGE, SKILLS, AND ABILITIES
OF MENTAL HEALTH COUNSELING. . . . . . ... 143

F LETTER OF INSTRUCTIONS FOR ROUND ONE ........ .. 145

G ROUND ONE QUESTIONNAIRE. . . . . . . ... 149

H MAJOR SOURCES OF KNOWLEDGE, SKILLS, AND ABILITIES
USED IN THE CONSTRUCTION OF THE ROUND ONE
QUESTIONNAIRE. . . . . . . . . ... 176

I LETTER OF INSTRUCTION FOR ROUND TWO. . .. . . 177

J ROUND TWO QUESTIONNAIRE. . . . . . . ... 181

K LETTER OF INSTRUCTIONS FOR ROUND THREE . . ... 205

L ROUND THREE QUESTIONNAIRE. . . . . . . .... .208

M FOLLOW-UP DEMOGRAPHIC QUESTIONNAIRE. . . . ... 234

N HIGHEST PRIORITY STATEMENTS OF GENERIC PROFESSIONAL
AND TECHNICAL KNOWLEDGE, SKILLS, AND ABILITIES NEEDED
BY MENTAL HEALTH COUNSELORS. . . . . . .. 236

0 SECONDARY PRIORITY STATEMENTS OF GENERIC PROFESSIONAL
AND TECHNICAL KNOWLEDGE, SKILLS, AND ABILITIES NEEDED
BY MENTAL HEALTH COUNSELORS. . . . .. ... . 243

P HIGHEST AND SECONDARY STATEMENTS OF GENERAL
PROFESSIONAL AND TECHNICAL KNOWLEDGE, SKILLS, AND
ABILITIES NEEDED BY MENTAL HEALTH COUNSELORS BY
CATEGORY . . . . . . . . ... . .. 251

Q LOW PRIORITY STATEMENTS IDENTIFIED IN THE STUDY. . 267

REFERENCES . . . . . . . .. .. .286

BIOGRAPHICAL SKETCH. . . . . . . . ... 301


APPENDICES


PAGE













Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

GENERIC PROFESSIONAL AND TECHNICAL KNOWLEDGE, SKILLS,
AND ABILITIES NEEDED BY MENTAL HEALTH COUNSELORS

By

Dan Alan Corley

March 1981

Chairman: Dr. Paul W. Fitzgerald
Major Department: Counselor Education

The purpose of this study was to create a list of perceived

professional and technical knowledge, skill, and ability statements

needed.by mental health counselors for adequate job performance in

community agency settings. The list was intended to comport a

rudimentary step in defining a national level of practice standard

for mental health counseling and provide, items that could be converted

to competency statements for use in the construction of a national

competency-based certification examination. The study was designed

to simultaneously allow field testing of knowledge, skill, and ability

statements suggested as important in the professional literature and

decipher the highly agreed upon high priority statements from the

low priority statements with greater deviation of opinion.

The study employed a Delphi Technique of three sequential rounds

of questionnaires. The object of the first round was to have the panel

generate new knowledge, skill, and ability statements and review the

items from the literature eliminating those not pertinent to counseling


viii








in field practice. The second round allowed the panelist to assign

importance levels or priorities to the statements. The third round

presented statistical description of the group response to each of

427 items from the second round. In the third round, the panelists

were asked to consider their Round II responses in relation to.the

group median and quartiles, and, then, respond to the items within

the quartile or make an opinion comment on those items that are

marked outside of the interquartile range. The median and inter-

quartile range of each item on the third round was computed and plotted,

and the statistical parameters of high priority items were identified.

The study produced two distinct levels of high priority-high

consensus statements of knowledge, skill, and abilities. There were

76 statement in 13 of 22 categories that were identified as top

level priorities.. In the secondary level priority group, there were

88 statements in 15 of the categories.' Two themes in the resulting

data are of critical importance for counselors and counselor educators

to consider. The statements high in both importance and agreement

emphasize service and character related components, few of which

strongly differentiate a professional from a nonprofessional mental

health worker. The categories having many identified items and the

categories having none define the counselor role in narrow terms

which do not support directions for training programs that deviate

from the fundamental relation of counselor and client in the therapeutic

setting.

Future studies should address the need to clearly define the
differences between levels of workers in mental health and human

services by the knowledge, skill, and ability components used at each







level. These studies must include a systematic investigation of the

interplay of counselor personal characteristics and values with

components of competence. The results, also, imply that a study

of the relevancy of curricula of mental health counseling programs

should be attempted.
















CHAPTER I

INTRODUCTION


Statement of the Problem

The health service complex in this country is one of the major

industries (Subcommittee on Manpower Credentialing (SMC), 1977).

America has a growing health care delivery system and a continual

need for health manpower (Robbins, 1972). Mental health is an

important part of the health care system and will make major contri-

butions to the general health of the nation in the future (SMC,

1977).


Manpower Needs and New Professions

There will be increased need for mental health service manpower.

The National Institute of Mental Health (NIMH) Division of Biometry

and Epidemiology reports that there will be an increase in the number

of mentally ill persons in the U.S. during the next decade. This is

due partly to population increases in age brackets with high incidence

of mental illness. If current manpower and service levels remain

stationary, there will be a chasm between services and need (Brown,

1976). Interdisciplinary approaches to health care are seen as one

method to provide for the increase in demand for service.










Interdisciplinary approaches require that professional identities

be enhanced by making more visible the distinctiveness of each

discipline (Bloom & Parad, 1976).

Increasing knowledge in health disciplines is indicated by the

continual growth in numbers of publications and research grants.

Initially, specialties within professions were developed because

the information in each profession was so diverse and voluminous

that the general practitioner could not meet the demand for

specialized treatment (Cohen & Miike, 1974). This demand for service

grew larger and outpaced professional ability to grow in service

delivery partially due to training limitations on health manpower

at professional levels (Robbins, 1972). The result of the dispro-

portionate relation of demand to service availability brought the

emergence of new professions to fill voids in the service delivery

system (Cohen & Miike, 1974).

The new professions of Nurse Practitioner and Physician's

Assistant have emerged due in part to the crisis created by the

limited supply of physicians (Cohen & Miike, 1974). The inadequate

supply of top level professionals in mental health also has contri-

buted to the emergence of new professionals and service workers

(Dugger, 1975). Testing personnel and paraprofessionals have been

utilized in mental hospitals and mental health settings for several

years.. The development of Human Service Programs in community

colleges and the growth of social service agencies has greatly

expanded the role of the.paraprofessional (Dugger, 1975). Federal

programs for drug and alcoholism rehabilitation have created a new










breed of counselor whose background often includes overcoming

addiction (Davis & Mandel, 1976).

The demand for services also has helped to create new profes-

sionals in mental health. The mental health counselor has emerged

as a recognizable professional contributing to mental health care

and providing a service unique to counseling within the health care

system (Forster, 1977).

The entire field of counseling has moved toward mental health

issues and concerns since the middle of the century, and many

counselors have led this trend through employment in community

agencies. This group of counselors serving in agencies has grown

rapidly over the past few years until a substantial percentage of

graduates from counselor preparation programs have assumed mental

health counselor positions in a variety of community service agencies

(Forster, 1977). Some counselor education programs recognizing this

trend and special needs of agency counselors have provided agency

related coursework, advanced counseling skills courses, and in some

cases an entire agency counselor tract of study.

Counselors have become a distinct specialty within the broad

field of mental health (American Personnel and Guidance Association

(APGA) Licensure Commission, 1977). Due to the actions of other

professions, mental health counselors became aware of the need to

formalize the profession and strengthen its position as an independent

mental health discipline (Sweeney & Sturdevant, 1974). Mental health

counselors began to organize in the middle seventies and at the 1977

Convention of APGA, the American Mental Health Counselors Association










(AMHCA) was accepted by APGA to start the process of becoming its

thirteenth division (Messina, 1980). Many state counselor groups

followed by joining the state branch of APGA (AMHCA, 1980). This

new national organization has set as an initial goal the construction

of a system for national level credentialing of mental health

counselors (Messina, 1979).

The gains from a national level credentialing process are many.

Among the foremost is to solidify the profession establishing

national standards for preparation and performance, i.e., to guarantee

the future of mental health counseling as an acknowledged discipline

in mental health. The certification process is seen as a major step

toward the professionalization of the field of mental health counsel-

ing (Messina, 1979).


Credentialing and Quality Control

Recently there has been more interest in credentialing on the

part of consumers. The health service consumers demand accountability

by the professions as health care costs rise. The consumer wants

assurance that increased costs are accompanied by high quality service

(SMC, 1977). Consumers look to credentialing to protect the public

safety and help the public identify qualified health service providers

(Cottingham & Swanson, 1976).

Licensure has traditionally been a sought after form of creden-

tialing by the professions (Hogan, 1978b). However, state licensure

of professionals has failed as a means of guaranteeing professional

competency or public safety (Gross, 1977). Licensure usually has been

self-serving and too often created a guild-like system within the










state whereby some competent professionals have been denied entrance

into licensed practice because of economic or political reasons

(Department of Health, Education, and Welfare (DHEW), 1971).

Licensure laws have not guaranteed competency or performance

quality (Hogan, 1978b). State licensure laws have differed greatly

within each profession. They have been rarely based on national

standards. This lack of uniformity in title, description of practice,

and definition has resulted in no reciprocity for professionals moving

between states (Cohen & Miike, 1973). State licensure has been cited

as restricting innovations in health care delivery and the emergence

of new professions (Hogan, 1978b).

Quality control of health services has become a major concern

as the health care system has grown (SMC, 1977). The demand for

service has been equalled by the demand for quality (Woodcock, 1972).

As some system of national health care insurance looms on the horizon,

there has been an increasing demand for professional accountability

and assurance of the highest quality health care (SMC, 1976). The

federal government has required guidance in spending money allocated

to health care. It has relied on recognized national level profes-

sional standards as the criteria of professional competence which

warrants federal spending (Cohen, 1977). It is clear that the direc-

tion of future Federal appropriations for payment of services will be

toward recipients that have proven competence under the national

standards of their professional associations (Cohen, 1977).

After the HEW studies, the Department of Health recommended the

development of national level certification for professionals under








guidelines set by a commission of voluntary certifying agencies. The

National Commission of Health Certifying Agencies (NCHCA) was formed

to set guidelines and assist organizations and certifying agencies in

developing certification procedures that meet the guidelines (Hogan,

1978b; National Commission of Health Certifying Agencies, 1977; SMC,

1977).

AMHCA set credentialing as the top priority for the new profes-

sion. Aware of the difficulties of licensure, AMHCA chose to

establish national level certification under National Commission

guidelines which require a competency-based examination of national

performance standards of the profession (Messina, 1979). In an

unpublished grant proposal to be presented to NIMH.jointly on behalf

of Professional Examination Service (PES) and AMHCA requesting

funding for test construction, it was clearly stated that the initial

step to the process of examination development is that the AMHCA

Board supply a list of generic knowledge, skills, and abilities on

which to base the examination (AMHCA, 1978). This list remains as

the necessary precursor to the chain of events that will result in

certification under the NCHCA guidelines and is the object of this

study.


Purpose of the Study

The purpose of the study is to establish a list of generic profes-

sional and technical knowledge, skill, and ability statements which

represent competent practice as perceived by mental health counselors

in community settings. This list of knowledge, skills, and abilities










will be developed by knowledgeable practicing mental health counselors.

It will provide information about high priority components of mental

health counselor performance. Individual knowledge, skill, and ability

statements are the basis for the development of competency statements.

These competency statements provide the pool of information for the

construction of a credentialing examination and serve as guides for

the development of a curriculum for mental health counseling.


Definitions

Abilities --"An ability is the power to perform an activity.

Implied is the lack of discernable barriers, either physical or mental,

to performance; also, the possession of prerequisite knowledge, skill,

or aptitude is implied. An ability is not an action and not an object

or result" (Gullion, 1979, p. 11).

Allied Mental Health Profession--"is any profession related to

certified Clinical Mental Health counseling providing services to the

public for prevention, diagnosis, and treatment of mental health

related problems, which includes psychiatry, psychology, psychiatric

social work, and psychiatric nursing" (National Academy of Certified

Clinical Mental Health Counselors (NACCMHC), 1979, p. 1).

Certification -- "is the process by which a non-governmental agency

or association grants recognition to an individual who has met certain

predetermined qualifications specified by that agency or association

to ensure that the public health, safety, and welfare will be reason-

ably well protected" (NACCMHC, 1979, p. 1).










Credentialing -- "is the formal recognition of professional or

techn ical competence. It is a generic term referring to the process

of certification and licensure" (NACCMHC, 1979, p. 1).

Delphi Technique-- "a carefully designed program of sequential

individual interrogations (best conducted by questionnaires) inter-

spersed with information and opinion feedback" (Rasp, 1973, p. 29).

Knowledge -- "A knowledge statement is an organized body of informa-

tion, usually of a factual or procedural nature, which, if applied,

makes adequate performance of the job possible" (Gullion, 1979, p. 11).

Licensure -- "is the process by which an agency of government

grants permission to an individual to engage in a given occupation

upon finding that the applicant has attained the minimal degree of

competency necessary to ensure that the public health, safety, and

welfare will be reasonably well protected" (NACCMHC, 1979, p. 1).

Mental Health Counseling- "is the process of assisting indivi-

duals or groups through a helping relationship, to achieve optimal

mental health through personal and social development and adjustment

in order to prevent the debilitating effects of certain somatic,

emotional, and intra and/or interpersonal disorders" (NACCMHC, 1979,

p. 1).

Proficiency Examination -- "is used to determine the level of

proficiency of practitioners with opportunity for those whose

competency is based, primarily on on-the-job training and experience"

(NACCMHC, 1979, p. 1).

Skills --"A skill is the proficient manual, verbal, or mental

manipulation of data, people, or things. Skill embodies observable









quantifiable, and measurable performance parameters. The demonstra-

tion of a skill implies the prerequisite knowledge and aptitude used

in the performance of the activity" (Gullion, 1979, p. 11).



Rationale

The NCHCA guidelines for the development of certification programs

and.agencies require that the certifying agency use criteria that are

based on the profession's national level performance standards which

must be field validated. If these standards do not exist then they

must be developed. In the case of mental health counselors, they are

being created as the certification examination is constructed. As a

result it is imperative that each step of the construction process

must involve practitioners. The first step of identifying the generic

knowledge, skills, and abilities must be done in a way that allows a

sample of practicing mental health counselors the opportunity to

generate items out of experience for consideration, review and refine

statements from the literature, and review all statements to create

an order by priority.

The Delphi technique is a method that is well suited to the needs

of this step. In a three round Delphi study, the first round allows

for the review and refining of literature statements and the generation

of new statements. The second round allows respondents to review all

statements and assign a level of priority to each. The third round

allows the panelists the opportunity to observe and comment on the

priority ratings that the group assigned each item to provide greater

depth and clarity to the results.









Assumptions

The assumptions pertinent to this study can be divided into two

general categories: (1) sample and population and (2) methodology.

Concerning sample and population, it is assumed that counselors in

community mental health centers are an appropriate population from

which to draw a sample. Further, this sample, drawn in the manner

described in Chapter III, will provide the most appropriate level of

expertise of informed respondents possible. It is assumed that the

nature, purpose, and structure of the community mental health centers

allow the highest probability that the sample selected will have

exposure to a wide variety of service modes, varying clientele,

interdisciplinary service opportunities, and counselor preparation

influences. It is assumed that the needs of counselors in community

mental health centers do not differ radically from agency counselors

in other settings and that the resultant list of generic knowledge,

skill, and ability statements will be of a nature that will gener-

alize to counselors serving in a variety of agencies.

Regarding assumptions about the methodology, it is first assumed

that the Delphi technique is the most appropriate device to employ in a

group decision-making process of this kind. It is assumed that Delphi

technique allows the best canvasing, refining, and reconsideration

of opinions regarding knowledge, skills, and abilities. On the

first round questionnaire, it is assumed that knowledge, skill, and

ability statements generated from the literature, will serve to

stimulate thinking of respondents and encourage original input.










Implications

The implications of this study are best reviewed in three primary

areas: implications for the profession, implications for the prepara-

tion of counselors, and implications for other professions. Under

each area there are specific implications.

In relation to the profession of mental health counseling, the

results of this study will contribute to a primary step in the

process of credentialing mental health counselors via NCHCA guidelines.

It will aid in the on-going development of professionalism. The study

will provide insight into the scope of practice and functions of mental

health counselors as determined by practitioners. Perhaps most

importantly, it will contribute to the professional accountability

of mental health counselors. This study will aid the current knowledge

of counselor skills and aid the process of refining accountability

procedures and objectives. Lastly, the study results will provide

new areas for research in mental health counseling.

Additionally, there are implications for the preparation of mental

health counselors. The results of this study will represent feedback

from the field on the actual abilities utilized and what abilities need

to be addressed in the preparation of agency counselors. The list of

knowledge, skills, and abilities could contribute to a guide for the

development of comprehensive preparation programs or tracts in agency

counseling. At the minimum it could be a checklist for departments

to insure that graduates of agency programs have acquired the needed

knowledge, skills, and abilities for agency counseling. The study will

also provide new areas for research in the preparation of agency

counselors.










The NCHCA, through an information exchange program, will share

the methods used by professions in establishing certification pro-

cedures. The study will provide other professions with an alternative

method of establishing the groundwork for their credentialing efforts.

Also, the identification of specific knowledge, skills, and abilities

in mental health counseling could lead to related professions making

similar distinctions. The end result would be a better understanding

of each professions' unique contribution to interdisciplinary health

care and the health care system at large.


Organization of the Study

The remainder of this dissertation will be organized into four

chapters. Chapter II will contain a review of related literature in

four broad topics. They are (1) the development of credentialing in

America relative to mental health counseling; (2) the development of

mental health counseling; (3) components of mental health counselor

competence; and (4) the Delphi technique. Chapter III will cover the

study methodology and will include the research questions, subjects,

and instrumentation, as well as the presentation of the study procedure

in each of three rounds with descriptions of each round data treatment.

Chapter IV will record data on panel composition, summaries of data

collected from rounds one and two, and the final results of the study

produced by the third round of the Delphi technique. Chapter V will

contain a discussion of these results and will be divided into two

sections. First, a majority report will discuss the consensus findings

of the study and the list of agreed priority knowledge, skills, and







13


abilities. A minority report will follow which will contain

opinions of participants not agreeing with the majority so as to

put the results in perspective and aid in fuller understanding.

Finally, there will be a discussion of implications of the study

with recommendations for future research to expand the utility of

the findings of this study in Chapter VI.
















CHAPTER II

REVIEW OF THE LITERATURE


The purpose of this chapter goes beyond the review of literature

pertinent to the four topics incorporated here: the development of

mental health credentialing; the development of mental health

counseling; components of mental health counselor competence; and

the Delphi technique. The intent of the section on credentialing is

to provide the reader with an understanding of conditions both

historical and current that influence the direction of future

credentialing efforts and compel professionals in health services

to consider soberly actions toward professional regulations with

primary regard to the public interest and secondly to the profession

as a part of a growing system of health providers. The section on

the development of mental health counselor profession is not intended

to be a comprehensive or exhaustive history. It is, instead,

intended to provide the reader with an understanding of developmental

influences that served, in part, to allow a confluence between mental

health counseling and psychology. This confluence in recent years

has been recognized along with the need to establish clearly the right

of existence and professional autonomy for the mental health counselor.










Credentialing of Mental Health Counselors

Credentialing Prior to the Seventies

Credentialing in mental health had received little attention as

an issue of regulating professions until the close of the second world

war. There had been early attempts at passing state law regulating

social workers but the attempts failed due to opposition within the

social work profession (Hogan, 1978c). World War II brought into

focus the fact that 17 percent of American men were unfit for military

duty on psychiatric grounds (Brown, 1976). This brought a post-war

focus on the lack of psychological services. The need for these

services mushroomed as Americans became aware of the emotional

causes of illness (Hogan, 1978b).

By the 1950's, articles on credentialing legislation for psycholo-

gists had appeared in the literature. Need for legislation was based

on the current demand for clinical services and the rationale that

"whenever any commodity is in great demand, government has an obliga-

tion to protect the public--to prevent fraudulent or opportunistic

exploitation of that demand--and to see that the public's needs are

met" (Heiser, 1950, p. 104). The regulatory procedure recommended

at the time was certification as opposed to licensure due to two

fundamental difficulties with licensure legislation: the fact that

there was no clear-cut delineation of what a psychologist does and

the fact that standards agreed upon for a licensing law would most

likely have a body of psychologists who could not be licensed

(Saffir, 1950). However, Wendt (1950) made clear that the legislation

considered by the American Psychological Association (APA) Legislative










Committee was licensing legislation. The purpose of Wendt's

writing was to recommend general practice legislation instead of

specialty legislation. He reasoned that enforcement agencies

would have difficulty enforcing a specialty exclusion when other

psychologists could legally practice because specialty licensing

would have negative effects on professional education limiting the

development of the profession and curricula, because the existence

of a specialty license only in clinical psychology would produce an

abnormal emphasis on service demands threatening continued research,

because there would be a danger of dividing psychology into splinter

groups by specialty, and finally, because the need for public protec-

tion would exist in the industrial and counseling fields as well.

The official position of APA was solidified in a report by the

Ad Hoc Committee on Relations Between Psychology and Other Professions

(1953). The report adopted by APA in 1953 recommended that APA should

support state legislation efforts, that this legislation should

certify by title and not restrict activities of a psychologist,

that psychologists are approved for private practice, and that APA

should oppose restrictive legislation that unduly limits the appro-

priate functioning of psychologists.

The impetus for psychology to use legislation to establish the

right to practice psychotherapy grew out of the conflicts between

organized psychology and organized psychiatry. In 1954 a joint

resolution was adopted by the American Medical Association, the

American Psychiatric Association, and the American Psychoanalytic

Association which stated: "Psychotherapy is a form of medical










treatment and does not form.the basis for a separate profession."

They went on to endorse "the appropriate utilization of the skills

of psychologists, social workers, and other professional personnel

in contributing roles in settings directly supervised by physicians"

(Hogan, 1978b, p. 28).


The Sociological Perspectives

The Committee on the Implications of Certification Legislation

(1958) of the American Sociological Society, reviewing the dilemma'

between organized psychology and psychiatry, prepared a statement on

the certification efforts of psychologists. The statement said that

sociologists, while sympathetic to the problem underlying the move

toward certification and appreciative of APA's intent to emulate

principles of a good profession, were concerned about the certifica-

tion movement and gave two fundamental reasons for that concern.

First, sociologists believed their claim on social psychology to be

as sound as psychologists. Restricting the use of the undefined word

"psychology" would at worst restrict continued work in that area and

at best have professionals in psychology judge the qualifications and

thus regulate the development of sociologists. Second, the establish-

ment of "psychology" as a legally sanctioned term could lead private

and public organizations to adopt the requirements of state boards,

thereby making inaccessible positions in social psychology to

sociologists. Sociologists would ultimately be viewed by the public

as incompetent to practice their traditional craft. Thus, the

Committee concluded that certification of the inclusive term psychology

would not serve the public interest in that it begins by preempting










a related profession's domain. The professional issues of the time

would remain central to the credentialing question as the more recent

literature demonstrates (Cottingham & Swanson, 1976; Sweeney &

Sturdevant, 1974). The political battle between organized

psychology and the medical community continued until the early

sixties by which time opposition to psychology had ceased. By 1977,

all states had enacted legislation regulating psychologists (Hogan,

1978b).

Sociologists took a dim view of the development of psychological

certification and questioned the appropriateness of certifying

academic professors (Borgatta, 1958). Borgatta noted that difficulty

in defining skills in psychology would threaten to preempt such

adjacent fields of practice as educational counseling, personnel

counseling, management counseling, human relations work, and social

work. Goode (1960) examined the pattern of professionalization and

its relation to the growth of emerging professions versus encroach-

ment claims of established professions. Goode was, by this time,

making observations about practicing professions including psychology,

as opposed to earlier views of psychology as an academic profession.

Social work, as a practicing profession, had long standing

interests in certification but had great difficulty in settling

internal professional disagreements necessary to accomplish the

passage of legislation. At the same time psychology overcame

resistance from the medical community, social work began to succeed

in legislative efforts with the greatest activity in the latter

seventies (Hogan, 1978c).










Influence of Third-Party Reimbursement

The rapid expansion of state licensure in the seventies was

influenced by the availability of third party payment of services.

In an article advising social workers of the need for involvement in

third-party payment systems, Kurzman (1973), pointed out that 95

percent or 64 million persons insured under Blue Cross have some

degree of coverage for nervous and mental disorders, and social

workers should be receiving insurance payments for services rendered.

Kurzman, in discussing obstacles to social workers' receipt of pay-

ments, wrote that insufficient standards governing the title and

practice of social work was charged by insurers, legislators, and

administrators and that they generally looked to licensing as an

appropriate standard. He discussed the resolution of the National

Association of Social Workers to pursue state licensing as needed

because legislators and insurance carriers were reluctant to recognize

the Academy of Certified Social Workers as an adequate standard for

private practice (Kurzman, 1973). Prior to 1970 only seven states had

passed statutes regulating social workers, while in the period between

1970 and 1977 there were 14 new statutes (Hogan, 1978c).

The reluctance that Kurzman addressed in 1973 was still a factor

by the close of the decade regarding insurance for mental health

services (Brown, 1978). Beigel (1975) suspected that this negativism

was not due to cost-effectiveness arguments. These have been effec-

tively proven in favor of mental health coverage (Reed, Myers, &

Scheidemandel, 1972). -There are instead other factors that impede

the acceptance of mental health benefits by legislators, lay people,









and insurers. These are accountability and quality control, pending

national health insurance, and adverse interdisciplinary relation-

ships (Beigel, 1975).

Kurzman (1973) speaks of the social workers drive for recogni-

tion by insurance carriers as an interdisciplinary struggle with the

primary opposition being the American Medical Association. He cites

that psychologists face the same opposition under the same arguments.

Beigel addresses the issue in the context of the medical versus social

model by saying

There is no question that professional organizations,
service delivery systems, and consumer groups are
tremendously concerned about whether the conflicts
between the various disciplinary groups will be
resolved in time to prevent a serious negative impact
on the mental health service delivery system. Not
that any of these groups alone is capable of destroying
the system, but there is no question that their in-
ability to date to each some kind of accommodation in
a number of areas is looked at with disdain by legisla-
tures and funding bodies. (Beigel, 1975, p. 194)

A further explanation of the medical versus social model conflict

is offered by Brown (1978). He states that some argue that mental

health problems are in the main not medical but problems of living

rooted in family and society and are expressed in problems in social

functioning and actualization of potential. Brown, however,

emphasizes the growing body of evidence linking serious forms of

emotional disturbance to biochemical and biological factors as a

buttress to the applicability of the medical model.

Difficulty in accountability is often linked to formulation of

acceptable goals; the more precise the goal, the less consensus on

acceptability (Denton, 1975). Stewart (1977) points out that









increased emphasis is being placed on accountability and suggests

that the evaluation criteria or goal formulation to which Denton

refers should have substantial input from psychologists as opposed

to bureaucratic accountants. However, few human service workers

have the academic training for accountability evaluation (Sommer,

1977; Williamson, Prost, & George, 1978). Only recently have

universities recognized program evaluation as a specialty and are

creating curricula to reduce functional gaps and meet the need for

professional identity and ethical character in evaluators (Schulberg &

Perloff, 1979). Schulberg and Perloff continue by saying that

academia's status and power have been crucial for bolstering the

fundamental rigor and credibility of other social sciences, and this

authority should now be exercised in support of program evaluation.

Psychotherapy services have become accessible to large numbers and
varieties of people. Also, there is great variety in therapies with

little research on the outcome. Society, through insurance executives,

public administrators, and legislators, is demanding that psycho-

therapists be accountable and show what can be done for whom, and

under what circumstances (Hadley & Strupp, 1977).

Pending national health insurance also affects the availability

of third-party payment for mental health services. For a decade

anticipation of national health insurance has been evidenced in the

professional literature (Brown, 1978; Woodcock, 1972). Articles
that discuss private insurance do not fail to mention pending national

health insurance in some form (Beigel, 1975; Chodoff, 1972; Kurzman,

1973).









Leonard Woodcock (1972), the President of the United Automobile

Workers Union, addressed psychiatrists on problems mental health

professions must help to solve in the health care system and outlined

a national health insurance proposal. He commented that private

insurance has failed to deliver "health care, cost control, or

universal protection" expected of it (Woodcock, 1971, p. 141). He

pointed out that private insurers are concerned with the exchange and

protection of dollars, not with the provision of health care services.

Further, they have refrained from activities of health planning and

health standards, deemphasized ambulatory care, ignored preventive

care, and expanded costly hospital care. In mental health, he

reported that they continue to promote major medical benefits which

act as a deterrent to early diagnosis and treatment.

Health planning and standards are typically a function of the

government (SMC, 1977). Although private insurers are not required

to adopt federal personnel requirement policies or payment criteria,

many have the tendency to do so thus reinforcing standards set by

federal agencies (Thomas, 1976). However, there are serious questions

as to what and who should be included in such policies in future

federal compensation programs (SMC, 1976).

A common assumption in the professions has been that national

health insurance would be distributed to providers who are state

licensed (Kurzman, 1973). Psychologists prepared a national register

of psychologists with state licenses (Wellner & Mills, 1977).

Representatives of several health professional organizations in a

joint statement later endorsed by the National Council for Community










Mental Health advocated state licensure as one of the criteria for

being a qualified mental health practitioner eligible for direct

reimbursement. Other criteria were a graduate degree in a mental

health specialty, two years supervised experience, designated as

qualified by a program of the professional organization, and relicensed

biannually with continuing education as determined by professional

associations (Goldberg et al., 1974).


Non Professional Developments in Regulation

Professions are interested more than ever before, in licensing

that follows a model of professionalism established by older profes-

sions with higher status (Matarazzo, 1977). In the past quarter

century licensure laws have doubled such that by 1976 there were

almost 2,800 statutory provisions that required occupational licensing

(Mackin, 1976). In 1065, only 120 professional associations were

involved in credentialing, but the figure today would be several times

higher (Jacobs, 1979). In a series of meetings at which state

officials discussed common problems relating to licensing, the major

concern of legislators was the proliferation of licensure and efforts

to bring the explosive growth of occupational regulations under

control (Shimberg, 1976). The rapidly growing number of health

occupations seeking and obtaining state licensure poses at least two

problems: (1) the proliferation of occupations and roles is likely

to contribute to inefficiencies in the health system; and (2) the

adoption of arbitrary scopes of practice in fields that will be under-

going substantial evolution over the next five to ten years (SMC,

1977).









Although there has traditionally been a hands-off policy on

the part of the federal government toward occupational licensing,

there is increasing evidence of a change of policy (Mackin, 1976).

Jacobs (1979) reports that certain aspects of professional creden-

tialing programs have come under legal attack or possible federal

regulation mentioning the Federal Trade Commission and the Department

of Justice as two interested parties. Mackin (1976) also indicates

activity on the part of the Federal Trade Commission as well as the

Equal Employment Opportunity Commission in occupational licensure and

urges counselors to become familiar with these regulatory issues.

The Department of Health, Education, and Welfare through the office

of the Assistant Secretary for Health has also been actively involved

in the regulatory process (DHEW, 1971).

Licensure has also been the active concern of state legislators.

Growing suspicions of the entire regulatory enterprise have been

heightened by revelations that many trade and professional groups

are using the power of licensing boards to foster anticompetitive

practices. Legislators have been urged by consumer officials to seek

hard evidence as to the need for regulation (Shimberg, 1976).

Licensure fulfills the fundamental role of establishing minimum

standards to protect the health and safety of the public (DHEW,

1971). However, requests for licensure seldom come from an out-

raged public seeking to end intolerable abuse. Instead, they usually

come from an occupational group that is the major beneficiary of a

licensure law (Shimberg & Roederer, 1978). It is well recognized

that licensing laws promote the economic well being of the profession

regulated and may be enacted with that purpose in mind (Hogan, 1978b).









Cohen (1973a) discusses professional credentialing in terms of

a profession's drive for autonomy. He says that professional status

results from the profession's claim to specialized competence. The

professional claims that he uniquely possesses the knowledge and

skills to define problems, set the approach to solving them, and

judge the success of the course of action in his or her area of

competence. The autonomy and special privilege accorded professions

is predicated upon three claims: (1) an unusual degree of skill and

knowledge is involved such that non-professionals are not equipped to

evaluate it or regulate it; (2) professionals are responsible and may

be trusted to work conscientiously without supervision; and (3) the

profession can be trusted to take proper action on occasions of

incompetence or unethical behavior. Professional autonomy is linked

to credentialing wherein prerequisites and standards of competence

are established for practice. Licensure by state, certification by

association, and accreditation are three parts of the credentialing

system over which the profession must gain control for autonomy.

This is tantamount to self-regulation. The state uses the professional

association as the source of guidance. State licensure boards are made

up of those recommended by the association. The power of the state

supports its standards and creates a socio-political environment in

which it is free from rivalry of competition and controls auxiliary

workers.

The ultimate goal of self-regulation leading to a closed shop

is a purpose for licensing that is at an opposite pole from public

protection. Most attempts at licensure fall on a continuum between









the two poles and while in recent years more attention has been given

to public accountability, the capture theory is not to be disre-

garded because the professions will attempt in time to gain control

over accountability as well (Cohen, 1977).

Others (Hogan, 1978b; Shimberg, 1976; Shimberg & Roederer,

1978) are not as systematic as Cohen in their identification of

professional benefits from licensure. Some of the advantages mentioned

are obvious even to the casual observer. The statutory regulation is

a symbol of respectability and demonstrates that the profession is

well established. This lessens the difficulty of attracting high-

caliber recruits and helps define the field more clearly. It also

controls the number and geographic distribution of practitioners

(Hogan, 1978b). Some licensing boards use their power to erect

barriers to restrict entry into the field, control the availability

and cost of services, and restrict competitive bidding (Shimberg &

Roederer, 1978).


HEW Licensure Studies

The growing public interest in the health care system and man-

power credentialing influenced the enactment of Public Law 91-519,

an amendment to the Public Health Service Act on November 2, 1970.

In that law Sec. 799A provided for the Secretary of Health to prepare

and submit to Congress a report identifying the major problems

associated with licensure, certification, and other qualifications

for practice or employment of health personnel (DHEW, 1971). The

first of the health manpower reports (DHEW, 1971) was an overview of

the state of professional credentialing and presented many of the











concerns about licensure mentioned earlier. In addition, it covered

problems encountered for licensure with career and geographic

mobility, foreign graduates, and demonstrating and maintaining

proficiency. The report recommended a moratorium for two years on

the enactment of legislation that would establish new health per-

sonnel categories, adoption and use of national examinations for

licensure, development of proficiency examinations, and the investiga-

tion of national certification and institutional licensure as alterna-

tives to the present system. A follow-up report provided greater

detail and justification for the 1971 recommendations, reported on

activity in the states, and urged continuance of the moratorium on

legislative activity while alternative credentialing methods were

being explored. Two reports followed; one reported that construction

of a system of national level certification of health providers was

feasible and should be undertaken (Sweezy, 1974). The other explored

institution licensure as an alternative and it was found lacking due

to political difficulties that would prevent initiation of an adequate

system (Storrer et al., 1976).

The Subcommittee for Health Manpower Credentialing (SMC, 1976)

prepared a final report with recommendations on the studies. How-

ever, the report when previewed by officials in various states did

not meet with total approval. In recognition of political pressure,

one recommendation was dropped, and wording was altered slightly in

a subsequently drafted and published version of the final report

(SMC, 1977).










The HEW studies had been founded on the premise that the only

reason for licensure was to protect the public from significant

harm to health and to safety (DHEW, 1971). The studies found that

licensure failed in this purpose, and, instead of making quality

health care more available, it served to enhance the professions

and harm the public (DHEW, 1977). Cohen (1977), articulating this

failure, pointed out that licensure, having concentrated on creating

restrictive (usually irrelevant) criteria for initial entry into a

profession, has virtually ignored the maintainence of competence

in those licensed. It has neither served to advance the development

of performance standards nor the development of competency assessment.

Reiff (1974) saw licensure as a self-serving device that professions

use to control knowledge as a commodity which if made available would

benefit the public.

Board compositions and board practices bear much of the responsi-

bility for criticism of licensure. Boards are almost always made

from recommended candidates from state professional organizations and

are thus tied to the politics within the state association rather

than selected on the basis of being the best qualified for board

service (Matarazzo, 1977). Board practices have been identified as

having contributed to poor distribution of practitioners and

specialists in the states (Cohen, 1977). Cohen (1973b) alsoidentifies

several reasons that Boards do not act in accordance with the dis-

ciplinary powers and responsibilities that are entrusted to them.

The reasons are










1. revoking a license means depriving a colleague of a means

of livelihood and an entire way of life;

2. law suits against Boards result in about a 50 percent

reinstatement of revoked licenses;

3. boards must often assume roles of investigators, prosecutors,

juries, judges, and executioners in proceedings which creates great

opportunity for the misuse of power and threatens the accused's right

of due process;

4. general ambiguity and lack of precision in statutory

provisions delimiting the groups for board sanctions; and

5. the role in assuring minimal quality has been limited to

initial entry (Cohen, 1973b).

Virtually every writer addressing the area of professional regula-

tion recommends some kind of reform and many are specific as to the

reforms needed. Cohen (1973b) addresses two general areas of reform

concern: (1) the rigidity of licensure that impedes geographic and

career mobility or the use of trained assistants and (2) the extent

to which licensure is a meaningful indicator or measure of competence.

More specifically, Cohen and Miike (1974) suggested expanded

responsibilities for boards which included (a) assuring initial

competence, (b) assuring continued competence, (c) formulating and

imposing discipline on errant practitioners, (d) determining specialty

and geographic distribution of those licensed, and (e) providing for

interprofessional coordination of new patterns of manpower utiliza-

tion. More recently, Cohen (1977) has called for the application of

more pervasive social controls on health manpower including competency










based licensure examinations founded on national standards, profes-

sional standards review organizations, continued competency

requirements for relicensure, and possible adoption of manpower

as.a public utility with requirements for service in unserved

areas for third-party remibursement eligibility.

Perhaps the most powerful recommendation for change in health

manpower credentialing came out of the HEW studies. The final report

quoted here (SMC, 1977) offered six recommendations which in one form

or another have been adopted and acted upon by various agencies.

They are

1. A broadly representative national (non-Federal) certification

commission should be established to perform the following functions

for allied health occupations:

a. Develop and continually evaluate criteria and policies

for the purpose of recognizing certification organiza-

tions and monitoring their adherence to the criteria.

b. Participate in the development of national standards as

proposed in recommendation 2.

c. Provide consultations and technical assistance to

certification organizations.

2. National standards for the credentialing of selected health

occupations should be developed and continually evaluated. Profes-

sional organizations, other elements in the private sector, and state

governments should play a significant role in this process. The

standards thus developed should be utilized for the various purposes

for which standards are required, including professional certification,

licensure, private sector and civil service employment, and third-

party reimbursement.










3. States should entertain proposals to license additional

categories of health personnel with caution and deliberation. Before

enacting any legislation that would license additional categories of

health manpower, states should consider the following factors:

a. In what way will the unregulated practice clearly

endanger the health, safety, and welfare of the

public, and is the potential for harm easily

recognizable and not remote or dependent on tenuous

argument?

b.. How will the public benefit by an assurance of

initial and continuing professional competence?

c. Can the public be adequately protected by means

other than licensure?

d. Why is licensure the most appropriate form of

regulation?

e. How will the newly licensed category impact upon

the statutory and administrative authority and

scopes of practice of previously licensed cate-

gories in the States?

4. States should take new steps to-strengthen the accountability

.and effectiveness of licensure boards that will allow them to play an

active role in assuring high quality health services. These include

a. Allocate increased funding, staffing, legal assistance

and other resources.

b. Assign high priority to disciplinary procedures and

responsibilities.










c. Adopt relevant national examinations and standards.

d. Expand membership on boards to include effective

representation of consumers and other functionally-

related health professions.

e. Establish appropriate linkages with the various

health licensing boards and between such boards and

other governmental health agencies responsible for

planning, development, and monitoring of health man-

power and services.

f. Develop a data capacity that is relevant to the formu-

lation of health manpower policy.

5. Certification organizations, licensure boards, and professional

associations should take steps to recognize and promote the widespread

adoption of effective competency measures to determine the qualifica-

tions of health personnel. Special attention should be given to the

further development of proficiency and equivalency measures for appro-

priate categories of health manpower.

6. Certification organizations, licensure boards, and profes-

sional associations should adopt requirements and procedures that will

assure the continued competence of health personnel. Additional

studies of the best mechanisms to assure continued competence should

be supported on a high-priority basis by professional associations,

the proposed national certification commission, state agencies, and

the Gederal Government (SMC, 1977, p. 7-16).

As mentioned earlier, a preliminary report was drafted and revised

prior to the final report. The recommendation that was delineated in









the final report is important to understanding the mood or inten-

tions of the federal bureaucracy. The recommendation was

Where personnel standards are deemed appropriate for
reimbursement under Federal health care financing programs,
such reimbursement should be limited to those services
rendered by health professionals who are either: (1)
licensed by state board who have adopted national standards
or (2) are approved by the proposed national certification
council. (SMC, 1976, p. 8).

The HEW studies have had great influence on the recent development

in manpower credentialing. In 1976, a steering committee met to

create the National Commission for Health Certifying Agencies and was

attended by approximately 70 professional organizations and agencies

(Messina, 1980). The purpose of the commission had been outlined in

the HEW recommendations. Initially the Commission created guidelines

that would create competency-based certification with national per-

formance standards and mechanisms to assist organizations with meeting.

those guidelines (NCHCA, 1977).


State Actions

With the National Commission established, one major area of the

HEW recommendations was started. The other major area was the reform

of licensure laws and processes. The most significant advance in

licensure reform has been the creation of Sunset Laws which call for

the automatic termination of government agencies or licensure boards

after a designated number of years unless reinstated by passage of new

legislation (Adams, 1976). Shimberg (1976) relates six questions

that are in the Florida Sunset Law (Chapter 76-168) which are

intended to help in the assessment of need for licensure and which

advocate parsimony:









(1) Would the absence of regulation significantly harm or

endanger the public health, safety, or welfare?

(2) Is there a reasonable relationship between the exercise

of the State's police power and the protection of the public health,

safety, or welfare?

(3) Is there another less restrictive method of regulation avail-

able which could adequately protect the public?

(4) Does the regulation have the effect of directly or indirectly

increasing the costs of any goods or services involved, and, if so,

to what degree?

(5) Is the increase in cost more harmful to the public than the

harm which could result from the absence of regulation?

(6) Are all facets of the regulatory process designed solely for

the purpose of, and have as their primary effect, the protection of the

public? (Shimberg, 1976, p. 144)

To assist state legislators in considering licensing, the Council of

State Governments published a booklet expanding the above questions

(Shimberg & Roederer, 1978). Sunset legislation has passed or is

being considered by over 30 states.

Recent Development in Counselor Credentialing

Accountability was a major concern to the counseling profession

during the seventies. Beymer (1971) advised counselors of the

dangers of ignoring quality in counselors. He predicted a malpractice

suit within the decade on a charge of negligence. The suit occurred

only three years later (Tarasoff v. Regents of California, 1975).

Brammer and Springer (1971) introduced a four-tiered system for









counselor credentialing in Washington which emphasized performance

standards rather than accumulation of credits, degrees, and experience.

Beymer (1971) also emphasized performance standards as the direction

for professional growth.

It was evident that counseling was growing in other ways as

well. Counselor education was a popular major and with a decline of

positions in public schools a greater proportion of students sought

positions outside of the schools (Forster, 1977). This may have been

evidence of Scott's (1971) assumption that novices look to their pred-

ecessors for guidance. His study of 1964 counselor educators showed

that 44.3 percent were members of APA and many were licensed

psychologists (Scott, 1971). It is no wonder that counseling is

perceived as developing under the wing of psychology (Forster, 1978).

Finally, the move away from schools was recognized in a Position

Statement on Counselor Licensure saying that members were increasingly

seeking positions in community agencies and private practices (APGA,

1974).

This movement out of schools by counselors was not sudden but

did not go undetected or unimpeded by organized psychology. A bill

was introduced into the New York legislature creating a hierarchy

of mental health workers with doctorates in clinical psychology at

the top. It was an attempt to control what was seen as widespread

quackery, and malpractice (Policing, 1973). However, the bill

ultimately failed with opposition from workers in specialized areas

of service objecting to forced supervision by clinical psychologists

(Riegelman, 1973). The attempted bill, however, introduced a logic










which was advocated at a national level. The Standard for Providers

of Psychological Services stated that providers who do not meet

the qualification of a provider as set in the standards shall be

supervised by a qualified psychologist. The interpretation accompany-

ing the statement made it clear that a service providerwith a

master's degree, associates, assistants, and clerks must be super-

vised by a qualified psychologist (APA Task Force on Standards for

Service Facilities, 1975).

This stand was further advanced by a new president of the

Psychotherapy Division of APA. His first address called for Division

29 to stand against APA recognizing as full members of APA those

master's degree professionals giving no reasons having to do with

competence but identifying the negative effect such recognition would

have on the receipt of third-party payments (Zimet, 1976). Zimet

denied that psychology is interested in containing competition, but

was worried about the balance of power in the profession if APA.were

to recognize potentially 40,000 master's members citing that APGA was

70 percent master's degree membership. Division 17, traditionally

close in goals to those of counselors, formulated a position statement

in 1977 with the American Association of State Psychology Boards which

identified counseling psychology as a specialty area distinguished

from related disciplines such as counseling and guidance, counselor

education, and counseling (Asher, 1979). Psychologists generally felt.

that counselors are unqualified in mental health and need supervision

(Goodyear & Derner, 1978). Positions such as these led counselors

to perceive the need for licensure initially as an issue forced by

psychologists (Gazda, 1977).










Counselors were introduced to the professional issues developing

in licensure by Sweeney and Sturdevant (1974) in their discussion of

the difficulty counselors were having in being licensed as psycholo-

gists. They suggested that licensure was an issue demanding the

attention of the profession and listed some alternative strategies

for achieving legal equality with psychologists including the

development of counselor licensure. Cottingham and Swanson (1976)

detained further difficulties in counselor licensure and articulated the

need for legal definition showing how this need was reflected in court

cases and state statute and national legislation. Mackin (1976)

warned counselors that licensure was a method by which the profession

could determine its own definition and avoid being defined by the

government. Counselors were provided a demonstration of how, without

action on credentialing, the profession could easily become completely

subordinate to psychology (Lindenberg, 1975). The basis for licensure

concerns were identified by Cottingham and Warner (1978) as follows:

1. litigation by examining boards in psychology on counselors

who were said to be practicing psychology.

2. a move toward supervision of all mental health workers

including counselors by psychologists.

3. Veteran's Administration requirement of state licensing for

psychology positions.

4. the need to define counseling.

5. failure of counselors to implement professional standards.

6. lack of national visibility of counselors.










The Cottingham and Warner (1978) article was part of a second wave

of counseling literature on licensure which identified needs for

licensure as a function of professional growth rather than as a

threat from psychology. An APGA Position Statement on Counselor

Licensure advanced three reasons for involvement in licensure develop-

ment:

1. APGA has a responsibility to consumers and society to insure

that people who hold themselves out to the public as professional

counselors are qualified to hold that title and to provide services

for a fee.

2. Membership has an obligation to strive toward effective

means of implementing the profession's recognized standards of

preparation and practice.

3. APGA has a responsibility to promote cooperative relationships

among related professions as equal partners in service to the public

(APGA, 1974).

Forster (1977) focused on the relation of credentialing to the

development and independence of the profession. He espoused that

credentialing must be based on a shared meaning of what a counselor

is and does and that there must be evidence or experience that

indicates effectiveness and value of what counselors do. Later,

Forster (1978) discussed the use of credentialing in defining counsel-

ing to remedy the profession's lack ofidentity. Rutledge (1973) saw

the need to set high standards for specialty counselors and Gianforte

(1976) suggested that credentialing meet the need for an introduction

to negotiations for third-party reimbursements.










APGA having committed itself to licensure (APGA, 1974) started

to take concrete steps toward licensure development. The APGA

Licensure Commission (1977) developed a licensure action packet with

a model bill to serve as a guide to states considering licensing.

The APGA Special Committee for Credentialing (1977) recommended con-

tinued pursuit of counselor licensing in its final report by saying

that the key to improvement in most areas of credentialing lies in

developing and implementing professional preparation standards.

American School Counselor Associated trained licensure consultants

for the various regions and ACES developed a proposal.for national

registry of Professional Counselors (Cottingham & Warner, 1978).

Warnath (1978) wrote about some of the political realities counselors

must consider when seeking licensing laws including compromises,

grandfathering, and exclusions in bills and hiring lobbyists. States

were becoming involved with news of success in licensing attempts in

Virginia and Alabama (APGA, 1979; Harris, 1977).


Return to Definition and Standards

The licensure efforts forced a return to the core elements of

the profession--definition and standards. Several authors have

written of the need for a definition of counseling for legislative

purposes (Asher, 1979; Brammer & Springer, 1971; Cottingham &

Swanson, 1976). Lack of adequate definitions in mental health was

recognized by Combs (1953) and has gone relatively unchanged (Hogan,

1978b). This need for definition may have-been most effectively

advanced by a report of a study of the effects of the deregulation

of psychology in Florida. The report cites definitions used by









professions that are broad and vague and allow a professional to do

virtually anything in the context of licensed practice (Staff of

the Senate Committee on Governmental Operations, 1979). Vague

definitions were not limiting enough to be definable in courts and

were among the reasons that Boards cannot take definitive action

against errant practitioners (Hogan, 1978b).

Forster (1977) recognized the difficulty of the growing counseling

profession's need for a definition that is flexible and open while

competing with other social service professions in a political climate

that encourages and may even demand fixed definitions and practices.

He advanced an area of identity for a definition of counseling as the

facilitation of human development. He stated that counseling more than

any discipline has focused its efforts on human development and adjust-

ment. Forster (1978) also used this idea of counseling to accentuate

its difference from psychology. He claimed that there are three

major distinctions: (1) psychology emphasizes the doctoral degree

while counseling emphasizes a two year master's program; (2)

psychologists work with psychopathology while counselors work with

normal populations; and (3) psychologists are involved in reorganiza-

tion of personality while counselors work with the personality's

existing strengths and weaknesses rather than restructuring the

personality. He suggested that counseling adopt a positive theoreti-

cal base such as Blocker's Developmental Counseling.

Equal to the need for definition is the need for commonly accepted

and applied standards of practice and preparation. Authors have

written about the importance of standards relative to credentialing

efforts (Cottingham & Warner, 1978; Forster, 1977) and some have










recognized that the standards should be practice related competencies

(Beymer, 1971; Carroll, Halligan, & Griggs, 1977; Rutledge, 1973).

Arbuckle (1977) speaking of practice standards, stated that if

licensure is to have meaning it must be directly related to the

professional function of the person being licensed, and that if

competencies can be determined, licensure should be .based on the

evaluation of them. Stripling (1978) seeking to influence the

foundation of counseling, stated that at the heart of professional

development are standards of preparation and that, through involvement

in standards of preparation and accreditation, counselors can gain

more visibility for the profession and play a more responsible role

in providing quality counseling and guidance services.

Alternatives to Licensing

Some counselors have been continually dubious of whether licensing

is a proper goal for the profession and have suggested alternatives.

Combs (1953) was perhaps the first to doubt the ability of licensing

to protect the public. Rogers (1973) advanced the view that licensure

did not serve the public interest. One of the difficulties cited

has been the use of academic exams for practicing professions (Wachowick,

1977). Arbuckle (1977) also questioned licensure's relation to the.

functions of the practitioner. One of the most articulate recent

critics of licensure has been Gross (1977). He said there are three

questions that are used to address issues of quality in mental health

services. They are

(1) How do you distinguish good services from bad services?

(2) Where do you draw the line?

(3) Who draws the line?









Gross maintained that in past licensure efforts the questions have

been asked in reverse order lending them ineffective. There was

little basis for restrictive legislation from the evidence of harm

or exploitation nor from substantial public outrage. He called

licensure a major support for a system that creates dependency on

professionals and reduces the consumers' ability to care for them-

selves.

Self-disclosure laws have been suggested as an alternative to

licensing (Gross, 1977; Swanson, 1979; Witmer, 1978). Such a law

would require a mental health practitioner to provide a client

information about counseling prior to service. Information would be

about the background, preparation, methods, and fees of the provider

(Witmer, 1978). Swanson (1979) suggested that the addition of a

consumer directory with information on selecting adequate service

would effectively arm the consumer for self-protection and negate the

need for licensure.

Another alternative is national level certification. The establish-

ment of a national certification.system and registry holds promise for:

providing visi-bility for counseling while aiding in the implementation

of standards (Cottingham & Warner, 1978). AMHCA was quick to

recognize the potential for such a system and the corresponding favor-

able political climate in the health care system to such an alternative

(Lindenburg, 1978). AMHCA began preparation for such a system (AMHCA,

1978). The certification procedures that were drafted (AMHCA

Certification Committee, 1979) were designed to conform in all ways

possible with the guidelines for application to the newly formed










National Commission of Health Certifying Agencies (NCHCA, 1979).

Messina (1979) provided a rationale for the establishment of

certification discussing Federal involvement in credentialing and

the National Commission's role in ensuring that certification

procedures serve the public interest in protection from harm and

availability of services. He mentioned also that the procedures will

provide the profession national level recognition in an area that

can be complementary to state licensure.


The Development of the Profession of Mental Health Counselors


The thesis .of this section is that mental health counseling as

a profession evolved from the common interests of counseling and

psychology and, due to organizational influences, societal changes;

and professional development, the need arose for the formalization

of the profession practiced by mental health counselors. It is assumed

that identification and understanding of these influences will help in

formulating a perspective on the future of the profession.


Early Developments

Antecedents to the development of a practicing counseling profes-

sion are found in the movements of the first half of the twentieth

century. Greatly aided by the mental hygiene movement led by Clifford

Beers, great interest was given to mental abilities and the professional

mental assessment movement (Shertzer & Stone, 1974; Tyler, 1969).

Assessment of mental abilities led the way to the practice of psychology

as most psychologists prior to 1950 were involved to a great extent in










clinical testing (Rabin, 1968). The movement aided counseling in

a number of ways in that it led to the study of individual differences,

creation of a testing code of ethics, and served as a basis for per-

sonality theory (Shertzer & Stone, 1974). Testing served also as the

backbone of the vocational counseling movement in the 1930's (Tyler,

1969). At that point in American history, vocational counseling,

identification of individual abilities, and job placement were of utmost

importance in providing stability to man (Wrenn, 1977).

The vocational counseling movement is generally regarded as the

foundation of counseling and guidance which from the beginning found

acceptance in education as an appropriate setting for the development

of vocational counseling approaches (Miller, 1973). It is the merger

of the vocational counseling and testing movements that is credited

for the development of counseling psychology as a specialty of psychology

(Super, 1955). From an historical standpoint, it is easy to see the

confluence of purposes and goals of guidance and psychology as reflected

in the APA Division 17. Even after changing the name of the division

in 1951 from Counseling and Guidance to Counseling Psychology, Super

(1955), writing of the division's evolution, clearly outlines the

similarity of interests and in fact shared leadership with the

newly formed APGA which was then thought to be an interest group

more than a professional organization.

The meshing of purpose and interests of the fields of guidance

and psychology in applied counseling settings is perhaps best

illustrated by examining the attempts to establish identity for

counseling psychologists through definition of counseling psychology.









The relation of vocational guidance and counseling psychology was

often an integral part of the definition. Blume and Balinsky (1951)

describe psychology's contribution to guidance and illustrate that

psychology is at the core of vocational guidance. They contend that

vocational guidance uses a clinical interview method, psychological

tests, and psychological research methods for evaluation. Further,

they advance the opinion that guidance, by enabling the resolution

of a problem or enhancing growth, is identical to therapy. Super

(1955) said counseling psychology deals with hygiology, with normalities

of even abnormal persons, and with locating and developing personal

and social resources and adaptive tendencies so the individual can be

assisted in making more effective use of them. While these two views

of an emerging field of applied psychology show the common perception

of the development and area of service or expertise of counseling

psychology, they also illustrate a basic difference that remains in

the literature as a stumbling block to the establishment of a clear

identity for counseling psychologists. The difference is the per-

ception of the nature of counseling. One view defines counseling by

motive or intent; that being the developmental enhancement of the

individuals normal qualities that help in managing stress, achieving

potential, and preventing emotional duress. The other regards counsel-

ing functionally as an interactive educational process with character-

istics and outcomes identical to those of psychotherapy.

The first school of thought, of which Super (1955) is evidently

a part, regards psychotherapy as a quasi-medical process practiced

by clinical psychologists on abnormal clients or patients involving










restructuring or reconstruction of personality. This point of view

is understandably conducive to interprofessional concerns in that.it

clearly separates counseling and clinical specialties. The functional

definition considers psychotherapy as an educational process which is

differentiated from counseling only by the severity of the client

problem. Rogers (1942) considers counseling and psychotherapy as

synonymous terms that, when they are intense and successful, are.

indistinguishable. This viewpoint is advantageous in defending

psychotherapy as a non-medical technique in right-to-practice battles

in the early 1950s (Hogan, 1978a).

The definition chosen by the definition committee of Division 17

leaned toward the developmental viewpoint, though not committing

totally to it. It said

The counseling psychologist wants to help individuals
toward overcoming obstacles to their personal growth,
whenever they may be encountered, and toward achieving
optimum development of their personal resources. There-
fore, this psychological specailist is found to be working
in the full range of social settings, e.g., school,
hospital, business or industry, or community agency.
(Committee on Definition, 1956, p. 238)

The definition, in concert with the journal literature devoted

primarily to vocational guidance and student personnel concerns, was

enough for the acceptance of the Division 17 name change and the

change of the diploma awarded by the American Board of Professional

Psychologists to "Counseling Psychologist" as well.

Another controversy that remained unresolved in psychological

literature and contributed to the development of professional mental

health counselor is that of whether to accept or reject master's level

psychologists. Woods (1971) provided an interesting history of the










issue through thorough research of the APA archives. He showed

that, at this point in the development of psychology as an applied

science, the attitudes on the issue were already clearly defined.

APA Committee on Subdoctoral Education surveys in 1952 and 1953

found (1) a substantial proportion of employed psychologists had

less than doctoral education, and (2) there was no agreement among

psychologists about the amount of training necessary for various

psychological jobs. Suggestions from regional meetings on the issue

centered on how Master's level psychologists might be controlled by

state law title restrictions, national examinations, or alteration of

training. These suggestions clearly indicated the attitude of the

leadership of the time. The 1955 Committee on Subdoctoral Education

noted that attitudes on subdoctoral training range from outright denial

of the desirability of having training at less than doctoral level to

the strong belief that the large bulk of psychological work has been

and will continue to be done by those with only a one year master's

degree in psychology. Patterson (1972) pointed out that APA had a

myopic concern only with psychology departments in Arts and Sciences

while the College of Education trained people for over 20 years in

one and two year programs to do psychological work. The Committee

recommended professional subdoctoral training for three reasons:

(1) need exists for workers at subdoctoral level.

(2) the number of doctorates then and in the future

would be insufficient to the manpower needs, and

(3) there would always be a number of positions not complex

enough to require doctoral services (Woods, 1971).










There were a number of influences that aided the development of

psychology as an applied science. The greatest boost came from the

post-war perceived manpower need in the mental health field (Brown,

1976). With the attention to returning veterans, the Veterans

Administration hired many master's level psychologists (Woods, 1971)

and, in giving attention to the needs of vocational rehabilitation,

the position of counseling psychologist was officially created in

the Veterans Administration (Committee on Definition, 1956).

Other events of the 50's more directly influenced the development

of counseling as a profession. The merger of the National Vocational

Guidance Association and the American College Personnel Association

to form APGA is the foundation for a profession (Shertzer & Stone,

1974). Wrenn (1978) reflected that one of the most significant

developments in the decade was the emergence and acceptance of two

new theoretical models. He explained that the work of Carl Rogers

provided an alternative to the prevailing clinical or illness model

of providing services and the work of B. F. Skinner advanced a learning

model concept into psychotherapy. He contended that they are develop-

mentally-based theories which allow the advancement of counseling and

counseling psychology. Wrenn also cited the availability of National

Defense Education Act funds as a significant event at the close of the

decade. The fund tripled the number of high school and college

counselors in seven years. This increase in numbers alone would

have advanced counseling as a profession. However, it was viewed

as a mixed blessing in that it also linked the profession to the

educational system and contributed to a lack of credentialing outside

of education (Sparacio, 1978).









The Community Mental Health Movement

The community mental health movement was an outgrowth of earlier

social movements in the mental health area. In America the movement

by Dorthea Dix toward the humane treatment of the mentally ill and

the later development of the mental hygiene movement provided a

foundation for the development of community mental health ideology

(Herd, 1978). The post-war public knowledge of the extent of mental

health needs in the country led to changes in treatment procedures

in that isolated and indefinite care was replaced by shorter term

on-site treatment (Beigel & Levenson, 1972). The National Mental

Health Act of 1946 provided funds for research and training and

created the National Institute of Mental Health. In 1955, the Mental

Health Study Act created the first national committee to study mental

health and develop a knowledge base for planning. The committee

reported almost epidemic proportions of mental health problems

including the information that 47 percent of all hospital beds were

filled with mental patients. A final report of the Joint Commission

on Mental Illness and Mental Health released in 1960 recommended the

creation of community mental health centers for every 50,000 people

(Herd, 1978).

By this time mental health as a social movement had grown

beyond preoccupation with the humane and optimistic concern for

the mentally ill to a movement involving the perceived happiness

and welfare of the total population. Recognizing this, Sanford

(1958) admonished psychologists for being irresponsibly silent on

the issue of guiding the movement. He noted that the psychologists










preoccupation with pathology or deviance was a deterrent to leader-

ship in a movement concerned with human effectiveness and a rich

psychic experience. Nonetheless, it was clear to him that psycholo-

gists perceived the movement in a clinical fashion as sickness-

oriented and with a one-to-one orientation.

In 1963, President John F. Kennedy spoke before the Congress

demanding a national system of community mental health centers to

replace the outmoded state.hospitals (Herd, 1978). This "bold new

approach" to mental health was to be primarily preventive in emphasis

through community intervention to correct social problems and provide

treatment .for existing disorders (Bloom, 1973). This would be

difficult under Sanford's (1958) assessment of prevailing attitudes

of professionals.

In Herd's (1978) discussion of community mental health ideology,

one can understand a progression of philosophy that moved during the

decade of the 1960's from a medical model relying on clinical

services to patients to a community psychologist model involving

intervention methods to treat the community as a whole to reduce

stress and keep problems from becoming serious. However, it has

been pointed out that among the initial five essential services only

one was preventive and the rest clinical, such that the design of

services was contrary to the philosophy of the community mental

health center (Brown, 1976).


Professional Identity Confusion

The events of the late sixties and early seventies had consider-

able impact on the mental health profession. Wrenn (1978) saw it as










a time when counselors were better professionally prepared for their

work but not better emotionally prepared for the upheaval of social

values and attitudes and the rapid rise.in drug abuse in the society

during the decade. In his opinion the rise of special problems in

.the society paired with advancing complexity of technology and

social problems led to the creation of a number of specialists in

mental health fields.

Against the backdrop of rapid social change and emerging

specialties in drug treatment, marriage and family therapy, sex

therapy, and other intervention systems, the inter- and intra-

professional difficulties continued toward resolution. The APA

position regarding master's level psychologists was again addressed.

in 1964 with the Greystone Conference on preparation of counseling

psychologists. The conference recommended that institutions initiate

and develop two year programs (Woods, 1971). The next year at the

Chicago Conference on preparation of clinical psychologists opposition

to master's level psychologists became apparent. The conference,

while not opposing master's psychology degrees, opposed master's

level training of clinical psychologists and maintained that master's

psychologists would have to be supervised by a doctoral psychologist.

The APA Education and Training Board in 1968 sent a resolution to the.

APA Board of Directors that the Board should take immediate steps to

meet the issues of membership standards and the scientific communica-

tion needs of non-doctoral level workers, many of whom were outside the

APA structure. This was recognition of a growing population of

service providers that did not seem to fit the mainstream of the









apparent APA direction regarding competent preparation. The follow-

ing year the Joint Subcommittee on Subdoctoral Manpower concluded

that society needs more manpower to do psychological work and

recommended that APA take an explicit policy position and follow-up

actions. That year there were two other reports worthy of noting.

A task force on conditions of employment for psychologists recommended

that the term Psychologist be reserved for only those with doctoral

level training. An ad hoc committee on subdoctoral training concluded

that even in the face of undeniable manpower needs, there was

resistance to training of subdoctoral professionals regardless of

whether or not they are considered to be potentially valuable (Woods,

1971). Zimet (1976) called for Division 29 to join Division 12 and

the American Board of Professional Psychologists in moving for a total

moratorium on master's level members. This attitude was further

accentuated by the National Registry of Health Service Providers in

Psychology. The register first limited registered membership to those

licensed in the states and, then, adopted the position promoted by the

Association of Examining Board in Professional Psychology by allowing

only licensed psychologists on the register who had a doctoral degree

from a department of psychology (Wellner & Mills, 1977). The position

by APA that psychologists should supervise all unrecognized service

providers (APA Task Force on Standards for Service Facilities, 1975)

made clear the commitment of organized psychology to a direction that

would create a hierarchy of non-medical service providers with doctoral

level psychologists at the top.









The Counseling Psychologist Dilemma

Division 17, in moving with APA policy away from master's level

practitioners was caught in an awkward position. Counselors were

beginning to identify their skills in vocational counseling and

developmental and preventative personal counseling--areas previously

claimed by counseling psychologists. Schneider and Gelso (1972)

studied the relation of vocational to personal emphasis in APA-approved

counseling psychology programs and surmised that counseling psychology

was moving away from vocational and educational concerns and challenged

the assertion that these environments of the individual can be claimed

as a unique specialty of counseling psychologists. Others considered

even a greater change. Osipow (1971) suggested that counseling

psychologists become increasingly involved in institutional change.

Patterson (1969) earlier had suggested that counseling psychologists

become social engineers changing masses of people. He noted that both

clinical and counseling psychologists were moving away from psycho-

therapy because of its lack of scientific support and it did not

take an M.D. or Ph.D. to do counseling or psychotherapy. He also

said that the great majority of counseling services were performed

by non-doctoral counselors who were not supervised to any appreciable

extent and if counseling did not require a doctorate then it did not

require supervision by a doctorate.

Diffusion of the counseling psychologists' identity was further

served by studies of counseling psychology programs. A four year

study of doctoral graduates of counseling and counseling psychology

programs discovered that only 24 percent of the graduates said that

counseling was their major function. The respondents formed two










clusters. Those from non-APA approved programs emphasized counseling

activities, were less likely to publish, read more in counselor

education and administration areas, and indicated less primary

identification with psychology. Those from APA approved programs

spent more time in teaching and research, indicated tests and

measurements as areas of research interest, and read more in the

area of psychology (Krauskopf, Thoreson, & McAleer, 1973). The study

concluded that counseling psychology was evolving away from the basic

training paradigm of the scientist/professional to a model of autonomous

segments of student personnel administration, professional psychology,

and behavior scientists. The findings of a study by Fretz (1975)

were somewhat contradictory. He studied curriculum rather than

graduates and found little or no difference between APA approved and

non-APA approved counseling psychology programs with respect to the

basic counseling and psychology core. Further, he found that there

was a lack of agreement on a common core of psychology courses which

he thought clearly related to professional identity issues. He con-

cluded that the psychology courses in the curriculum should (but do

not) differentiate the counseling psychologist from the counselor not

trained in psychology. These studies indicated some discrepancy

between the preparation and work of the graduates of counseling

psychology programs. They also reflected the involvement of counselor

educators in counseling psychology.


Changes in Counselor Education

Brammer (1968) further emphasized the counselor educator's self-

concept as a counseling psychologist by pointing out that two-thirds










of NDEA institute directors were APA members in 1965-66. Other

studies have reflected counselor educators affiliation with Division

17 of APA that rivals affiliation with APGA (Scott, 1971). This

seemed to reflect a growing mental health interest which was trans-

mitted to students (Scott, 1971). With only 20 percent of counseling

psychologists reporting counseling as a major function, it was clear

that a growing proportion of mental health services were provided

by master's level counselors (Patterson, 1969). Counselors were

encouraged toward mental health by the manpower projections indicating

a need for a useful approach to mental health services that would be

developmental and preventative in nature (VanHoose & Pietrofesa,

1970.

In the mid-sixties there were still references in the literature

that considered all counselors to be psychologists (Brammer, 1968;

Campbell, 1965). It was clear that the counseling literature was

developing an identity of counseling as a separate profession

(Blocher, 1966; Hill, 1967). APGA and its divisions had worked

steadily toward the development of standards of preparation and

performance for master's level counselors (Hill, 1967; Loughary,

Stripling, & Fitzgerald, 1965). With the emphasis that APA placed

on the doctoral degree as a symbol of professional adequacy,

counselors were reaffirmed by the discovery that relationship

qualities are more determinant of counseling effectiveness than

academic degrees (Truax & Carkhuff, 1967).

The late 1970's brought an increase in professional political

activity. The licensure issue with the corresponding issue of









professional supervision (Corley, 1979) moved the professions of

counseling and psychology further apart. With doctoral graduates

of counseling programs being denied the opportunity to sit for

psychological licensure examinations (Cottingham & Swanson, 1976),

and the courts recognizing counseling as a separate profession

(Sweeney & Wittmer, 1977), it was evident that counselors would

have to move toward separate legal recognition. APGA began the move

for separate equal licensure for counselors (APGA Licensure Commission,

1976) and adopted standards for preparation of counselors which had

taken several years in creating (Stripling, 1978). By the close of

the decade, the professions were separated to the extent that some

considered them at odds in their purposes and direction and.were

critical of dual membership (Lindenburg, 1978).

Counseling psychology moved away from its foundation in develop-

mental counseling and vocational guidance and continued to have

influence in APA (Fretz, 1977). In so doing it rejected any

affiliation with counseling and guidance (Asher, 1979). This renewed

concern over the identity of the counseling psychologist. Kagan

(1977) in the Presidential Address of Division 17 defined the counsel-

ing part of the profession as preventive, health-oriented, educational,

and helping people to live happier more productive lives; and noted

that these things were common to counselors, guidance workers, college

and student personnel workers. The psychology part was defined as

possessing a doctoral degree from a department with psychology in the

title. Super (1977) considered the issue a virtual identity crisis

for counseling psychologists. He pointed out that the trend of moving









toward clinical psychology and away from personnel psychology gives

up counseling psychology's special identity and made counseling

psychologists appear to be simply another group of clinicians with

no real claim to separateness. This was accentuated by the move to

private practice. Super suggested that the identity of counseling

psychologists was best enhanced by helping clients use institutional

resources for self-enhancement. He warned that counseling psychologists

and school counselors were making the same mistake by rejecting voca-

tional counseling and were giving it to less qualified people such as

vocational education instructors.


Mental Health Counselors Emerge

The mid-nineteen seventies saw a large and growing number of

mental health counselors in public agencies and in private practice.

APGA had not specifically embraced mental health as a part of the

organization's mission. APA had rejected full membership at a master's

level and thus a large segment of mental health workers experienced a

void in professional identification or in a group with which to

affiliate and a lack of professional services such as political

advocacy.

Community mental health workers acutely aware of the void began

to make moves toward filling it. Gary Seiler made a request to APGA

in 1975 that a new Division be created and Frank Biasco wrote the

Guidepost newsletter editor to suggest that an interest group by

formed in mental health counseling by APGA. Generated from the ideas

of Nancy Speissoand Jim Messina, a group of 17 counselors formed a

new organization to serve the interests of those disenfranchised






58


mental health workers (Messina, 1980). Prior to the Dallas APGA

Convention, an organizational conference was held. The group had

grown to a membership of 600 in a few months and had adopted the

name American Mental Health Counselors Association (Messina, 1980).

At the 1976 Dallas Convention, APGA lifted a moratorium on new

divisions allowing AMHCA to start the motions toward affiliation.

After AMHCA held an election on the issue, a narrow margin of votes

sent AMHCA in the direction of affiliation with APGA as the thirteenth

division.

AMHCA grew rapidly in membership which was evidence of many

counselors experiencing the same need for a group identity. By the

Spring of 1980 the membership had grown to over 4,000 (AMHCA, 1980).

The AMHCA leadership decided that the need for a clear identity

could best be met by political action on the part of the national

organization and an extensive credentialing system. AMHCA identified

certification as a top priority for the new organization (AMHCA,

1978). Certification at a national level would give counselors a

credential based on a performance standard and would not have many

of the disadvantages of state licensure (Messina., 1979; Lindenburg,

1978). AMHCA established the certification procedures under the

guidelines of the National Commission of Health Certifying agencies

and created the National Academy of Certified Clinical Mental Health

Counselors (NACCMHC, 1979). Soon after the National Academy began

certification of counselors, one of its members was accepted by the

court as an expert witness based on the certification (AMHCA, 1979).










For political recognition, AMHCA began to lobby in Congress

for inclusion of mental health counseling as a mental health profes-

sion in various health funding legislation (AMHCA, 1979). Also,

several state organizations began to move for state licensure of

counselors and AMHCA created a state licensure network and a match-

ing grant for lobbying funds for state efforts.

The creation of the AMHCA Journal was a move to advance the

literature in the counseling profession and attend specifically to

the interests of mental health counselors (Weikel, 1979). It was

thought that a clear professional identity would be generated through

discussion in the literature. Seiler and Messina (1979) proposed

such a dialogue for mental health counselors and advocated an

identity which is preventive and developmental. They conceptualized

mental health counseling as a holistic, multifaceted process for the

promotion of healthy life-styles and preservation and restoration of

mental health. Their view seemed to have been adopted by many as

it is reflected in various licensure proposals. Forster (1978)

indicated that the process of pursuing licensure has brought counselors

to seriously deal with defining the profession and has thus promoted

clarity of identity; an identity which is defined in terms and

concepts similar to those of counseling psychology of a quarter of a

century earlier. However, the identity needed to be criterion-related

for credentialing proposed. This made it imperative that mental

health counselor competencies be generated from the component knowledge,

skills, and abilities of counselors.









Components of Counselor Competence

The provision of human services, the education of counselors,

the pursuit of credentials, and the effort in professionalization

in counseling have all been strongly effected in recent years by

the public demand for accountability. Challenges to institutions

to prove their worth have become so prevalent that they appear to

characterize the current era. As an answer to these demands, the

growth of competency-based and criterion-related educational programs

has been rapid. Thirty-five states have instituted legislation or

state agency action competency testing in the educational arena

(Perrone, 1979). Two reasons for the growth of competency-based

testing which were first identified by Winsor Lott in a 1977

Personnel and Guidance Association Newsletter were (1) public

concern that certificates, licenses, diplomas, and other forms of

credentials were awarded to individuals who lack the basic skills

to justify them; and (2) the costs of education, health care, and

human services were sufficiently high to require accountability as

proof that taxpayers are getting something of value for their invest-

ment (Perrone, 1979). Indeed the most important issues in health

services in the 1970's were skyrocketing health care costs, pressures

for some form of national health insurance, the clamor for competing

recognition by new and more specialized health organizations,

competency issues, equal employment challenges, and the Federal Trade

Commission's demand that accrediting bodies reform their monopolistic

practices (Southern Regional Education Board (SREB), 1979a). The

latter issue had the effect of accelerating the competency assessment

movement in areas of professional credentialing.









The Competency-Based Issue

While proponents of competency-based assessment enumerate the

various benefits of such a system for use in a variety of settings,

the growth of the movement is probably due to its perceived answer

to the socioeconomic climate rather than on the merits of the good

that is to be gained from the employment of competency-based assess-

ment systems. Critics of competency-based education and credentialing

identify one substantial argument with competency systems on the

whole. Adequately described by Diamonti and Murphy (1977), the argu-

ment is that, in human services and in education, the sum is greater

than the component parts. They contend that behavioral objectives

in a rehabilitation counselor education program seek certainty of

outcome at the expense of scientific flexibility and curiosity and

thus lead to efficient but superficial and misleading ideas of

scientific approach to graduate preparation. Further, behavioral

objectives define counseling in limited terms and endanger the ex-

perience of the whole, limiting the exploration into diverse opinions

of definition and producing narrow mindedness. As course goals,

they influence the course content to the extent that subsequent

evaluation is not an objective assessment but is instead the dictate

of course content. This last point is underscored by Perrone (1979),

who demonstrates historically that, where competency tests exist to

certify the accomplishment of academic goals, test items dictate

content of academic curriculum even to the point of ignoring a non-

test related organized curriculum. This is obviously a caution to

those building competency-based certification systems to take great










care in item selection, test construction, and system flexibility

and renewal.

Proponents of competency-based education and certification

systems usually respond to criticism by explaining the flexibility

of competencies or suggesting that some of the hypothesized ill

effects of competency-based systems are as yet unproven. Agreeing

that competencies should dictate the curriculum,.proponents advocate

that competency statements specify the transferable process skill and

address a general subject matter. A skill statement, such as "can

design and implement an evaluation plan," has great flexibility for

the context in which the competence is demonstrated. Thus considerable

freedom is allowed for both faculty and students (Butler, 1978).

Other proponents have argued that competency-based counselor education

programs utilize skills that have been proven beneficial by scientific

method and do not lead to a misconception of science (Anthony, DellOrto,

Lasky, Power, Shrey, & Spaniol, 1977). In answer to the general

criticism, disciples of the competency-based method contend that

learning the component parts is essential to the artful performance

of the whole (Anthony et al., 1977), and that when students or profes-

sionals demonstrate a set of competencies relating to a function, the

completed whole will, in fact, be greater than the sum of its parts

(Butler, 1978). These arguments may, however, be purely academic as

it seems that enough legislators, education, and credentialing agency

administrators, and consumer advocates have seized on competency-based

systems as the accountability answer to make such systems a very

influential part of our near future. However, good things become fads








because of over-emphasis or because of trying to accomplish objec-

tives too rapidly, and competency-based education could be destined

to be discarded in search of some future innovation (Kennedy, 1976).

Counselor Competency Issues

Criticisms that are more productive are those that provide

insight into current weakness in competency-based approaches or lack

of knowledge in areas which make their use difficult. One such area

for counselors is the lack of agreement on several aspects of profes-

sional preparation. Bernstein and Lecomte (1976) identify the lack

of an agreed idea of training goals, what is therapeutic, program

emphasis, definitions, and the nature of supervision as deterrents

to a training model which is competency-based. Their answer to the

difficulty of definition is to design educational programs to teach

one how to build a competency system. Another difficulty cited is

that the state of the art of evaluation is not sufficiently advanced

to provide bias free assessment (Perrone, 1979). Others disagree

saying that the evaluation mechanisms exist but that the perspective

from which an act is evaluated may bias the resultant judgment of ef-

fectiveness (Strupp & Hadley, 1977). Wheeler (1980) points out

that, while counselors are increasingly responsible for accountability

in counseling, they perceive themselves as naive in areas relating

to evaluation and ill-prepared to adjust to accountability demands.

The result may be a hesitancy to engage in competency-based procedures.

One of the greatest difficulties in the creation of effective

competency-based programming and credentialing in counseling is what

Cole and Lacefield (1978) have termed the Krathwohl-Carkhuff paradox.






64


The underlying democratic principles that govern counseling, as well

as the greatest part of education, dictate that no one should be

denied the right to do something (counsel) based on inherent

characteristics or beliefs. Instead, denial should be due only to

the lack of ability. With the discovery that counseling effectiveness

is to a great degree determined by certain characteristics or attitudes,

a paradox arises such that the ability to counsel effectively is

intertwined with affective elements. Affective skills and character

traits that enhance counseling effectiveness are well-documented in

the literature. Wittmer and Lister (1971) found no correlation between

academic measures and counselor effectiveness, but did find correlation

between personality characteristics and counselor behavior or effective-

ness. More specifically, Myrick, Kelley,and Wittmer (1972), using

the 16 Personality Factor Questionnaire, found that characteristics

of effective counselors were more outgoing, stable, warm, assertive,

happy-go-lucky, casual, venturesome, and sensitive. Level of self-
awareness has been related to effective counselors (Jansen & Garvey,.

1974). Affective skills that have had great attention are the core

dimensions of the helping relationship and dictate a characteristic

attitude of the effective counselor (Gazda et al., 1977; Truax &

Carkhuff, 1967; Wittmer & Myrick, 1974). Differences of opinion arise

in how to measure the core dimensions (Blaas & Heck, 1975), but their

relationship to effective counseling is undeniable.

Studies have been made to discover derivative characteristics.

Jones (1974b) discovered that there are significant correlations

between tolerance for ambiguity and both empathic understanding and









respect and thus tolerance for ambiguity is characteristic of

effective counselors. Graduation from graduate education may

testify to a high tolerance for ambiguity. Menne (1975), in a

competency study identified 132 competencies in 12 categories.

The top three categories in order of importance were Professional

Ethics, Self-Awareness, and Personal Characteristics, again under-

scoring the importance of attitudes, beliefs, and characteristics

over technical skills.

Still, in the face of scientific inquiry in support of charac-

teristics and effective skills (Carkhuff, 1969; Jones, 1974; Loesch

& Rucker, 1977; Myrick & Kelly, 1971), there is continued reluctance

to use them in the credentialing or in the selection of trainees or

employees. In a discussion of an attempt in the Georgia Department

of Education to establish competency certification, this reluctance

is explained. Competencies have both knowledge and performance

dimensions. Attitudes are not included in the definition of competencies

because those identified are impossible to define and measure to any

degree of reliability or validity and, as presently measured, are

believed to be essentially unrelated to performance (Bernknopf,

Shultz, & Ware, 1979). Cole and Lacefield (1978) suspect that the

reasons run deeper. Discussing why affective objectives and assessment

have disappeared from professional education, they list four major

influences:

(a) Cognitive terms are easier to measure;

(b) Teachers are reluctant to grade affective growth;

(c) There is a western ethic in support of privacy of

affective goals; and








(d) The educational system is set up for the accumulation

of cognitive skills which are less influenced by early

life experiences.

They surmise that, although affective skill areas can be stated

as goals, taught to many persons, and competence in skills assessed,

strong cultural norms may prohibit all three.

Competency Generation and System Organization

Competencies are obtained from two sources according to McCleary

(1976): (1) job analysis of practice and (2) the knowledge base of

the field-authoritative literature. The two are reflected in approaches

to competency generation outlined by Houston (Tolsma, Chiko, Marks,

Kahn, & Friesen, 1979). They are

(a) Program translation--reformulating current training pro-

grams into competency statements.

(b) Task analysis--writing competency statements based on role

descriptions.

(c) Needs assessment--using the perceived preferences of a group

of people as the source of competency statements.

(d) The cluster approach--the deductive analysis of program

areas such as group counseling.

(e) Theoretical position--logical and deductive building of a

program based on a theory.

(f) Client centered analysis--competencies based on the need of

a given individual.

Tolsma et al. (1979) added that selecting from an existing domain of

statements although there is not a standard format is another approach

to competency generation.










Medley, Soar, and Soar (1975) describe two kinds of competency

statements: those that are long and specific and those that are

short and general. Competencies at random are of little use;

therefore, some system is desirable so that their relation to one

another can be understood. Butler (1978) explains that a hierarchy

of competencies is necessary to differentiate levels of competencies

with regard to specificity moving from the general to the specific.

An often-used method of creating such a hierarchy is to develop a

taxonomy by relating components in a logical sequence.

Dagley (1972) points out that an issue in the use of a taxonomy

is that its classifications are related to relevant theoretical views

available to fully account for the numerous counselor behaviors and

skills. Another issue is that much of counseling seems to be of a

nature that defies precise agreement or definition. A taxonomy can

be designed hierarchially such that lower level components serve to

define higher level components. The field or area of concern is

divided into domains of content which are further divided into

major classes. The classes are composed of categories of functions

or information which in turn are derived from grouping specific

elements. An example of such a hierarchy can be found in Chapter III.

Several systems have been advanced in counseling for use of

competencies or behavioral objectives. Most of those that use a

hierarchy choose a narrow field, i.e., consultation or counseling

theory. In a review of systems, Chiko, Tolsma, Kahn, & Marks (1980)

found the following kinds of problems.

(1) lack of an adequate categorizing system;










(2) disproportionate distribution of competency statements

across the categories;

(3) absence of competency statements describing certain tasks;

(4) confounding of knowledge,. skills, and characteristics

within many statements; and

(5) variation in level of specificity across the domain of

statements.

It is evident by the criteria that a good model must be comprehen-

sive and balanced with enough specificity for distinct content and

clarity of hierarchial level. It is obvious that this proves to be

a complex task in any area. However, another variable must be kept

in mind when selecting items for the hierarchy, and it includes the

levels of counselor development at which the counselor may be

assessed. Medley, Soar, and Soar (1975) identify four levels for

teachers that can be paraphrased for counselors:

1. Training experiences the courses or modules accomplished

during preparation.

2. Counselor performance measured while trying to fulfill

role.

3. Client experience measure of the effect on the client

during counseling.

4. Client outcomes post-counseling effects on the client

behavior.

The majority of evaluation in counselor training concentrates

on the first level while credentialing evaluation centers on the

second. The third and fourth levels are generally regarded as beyond










the current state of the art of evaluation in counseling, although,

they have not been forgotten in the literature.

Recounting that most of the literature described differences

rather than similarities among theories, Cogan and Noble (1979)

attempted a ratings study on 98 counselor competencies found in the

literature and divided into six classes. Raters were 51 counselor

educators and competencies were principally from a dissertation by

Menne. The Menne list of competencies was developed from a procedure

not unlike the Delphi technique except competencies were drafted and

rated by different samples. The results from a poor return yielded

132 competencies in 12 classes (Menne, 1975). The study was criticized

by Neil (1976) in that nine of the 12 classes were judged significantly

different in priority by respondents from different theoretical

orientations and majors. He suggested that this finding supported

the need for a structural model for deriving counselor competencies.

Neil's model is based on the perceived developmental sequence

in the counseling process. There are five skill domains: assessment,

interaction, decision-making, program development, and evaluation.

These domains are matrixed with five targets of skills (individual,

family, group, agency, and community) to create 25 classes. Skills

are classified as either generic or situationally specific in type.

A structural model such as Neil's allows for more comprehensive

coverage of the role of the counselor and allows adequate classifica-

tions of skills. However, when used for generation of competencies as

suggested, there exists the opportunity to overlook necessary skills

for clinical practice.










Another structural model was one designed originally for employ-

ment counselors and later was generalized as a method of creating

competency statements as well (Chiko et al., 1980). The model that

Chiko and his colleagues advocated has two parts: a categorizing

system and a procedure for writing competency statements. Three

domains represent the kind of component competencies in each: content

or knowledge; function or performance; and personal characteristics.

There are 28 classes in the domains. Using the standard format for

writing competency statements, the authors have developed in excess of

4,000 individual competency statements.

In his hierarchical taxonomy of counselor education objectives,

Dagley (1972) uses three domains: technical, professional and personal,

each having the three classes of perceptualization, conceptualization,

and generalization. These further break into 25 categories of

knowledge and functions. A comparison of the intermediate level

categories of functions and knowledge between Dagley, Neil, and

Chiko et al. can be found in Appendix D.


Competency Applications in Counseling

"If training is to be meaningful, then specific operational

criteria for counseling competency needs to be identified and defined"

(Cogan & Noble, 1979, p. 120). This statement represents the aspira-

tions of many of the contributors to the professional literature in

counseling. Counselor education has found a variety of applications

for competency-based training programs in their preparation of new

counselors (Beamer, Berg, Bonk, Dahm, Dameron, Landreth, Medler, Robb,

Wilborn, & Williams, 1973; Fuller, 1975; Gavilan & Ryan, 1979).










Weitz, Anchor, and Percy (1976) reported on a competency procedure

for the selection of a new counselor education faculty member.

Other counselor educators have applied competency-based systems to

student development specialists or college personnel workers (Hanson,

1977; Newton & Richardson, 1976), and to school psychology intern-

ships (Catterall, 1973). Competencies have been used to create

counselor renewal systems for updating the skills of those counselors

in the field (Benjamin, 1980). Community colleges have used competency-

based systems in the training of human service workers (Duncan, Korb, &

Loesch, 1979) and competency-based programs have been created for ex-

addict substance abuse workers (Davis & Mandel, 1976). A competency

approach has been advocated for teaching life skills to clients

(McClelland & Boyatzis, 1980). One of the areas of greatest activity

with respect to development of competency-based approaches has been

in the area of counselor certification. Attention to competency-

based school counselor certification has been evident in various

states (Bernknopf, Shultz, & Ware, 1979; Florida Department of Education,

1980; Shoemaker & Splitter, 1976). Sponsored to a great degree by the

federal government, there has been a flurry of activity to create

competency-based certification systems for alcoholism counselors

(ADAMA/NIAAA Planning Panel, 1977) and substance abuse workers

(Stephen & Prentice, 1978; Vasquez & Ford, 1978; Ziener, 1977). The

National Academy of Clinical Mental Health Counselors is in the process

of creating competency-based certification for mental health counselors

(AMHCA, 1979).










Competency Content Knowledge, Skills, and Abilities

The content of a competency or a competency-based system is the

knowledge, skill, or ability on which it is based. Therefore, the

first step to the development of competencies in counseling, as in

any field, is the discovery of generic knowledge, skills, and

abilities. This process begins with surveying the professional

literature.

There is a growing volume of literature that not only suggests

new areas of knowledge for counselors but serves to describe, in

relatively exact terms, abilities that counselors need for increased

effectiveness. Heightened, also, is an awareness that goals and

competencies must be job-related and that their outcomes must be

relevant to or required by counselor roles in various employment

settings (Horan, 1972; Stokes, 1977). This has been required of

assessment procedures for certification requirements by several court

actions (Bernknopf et al., 1979).

Riggs (1979), in his review of counselor effectiveness evaluation,

found that evaluation of the counseling process focuses on core

facilitative conditions. It is obvious then that most comprehensive

systems of counselor knowledge or competence have the facilitative

conditions as a large part of the content. More specifically, these

facilitative conditions can be divided between relationship variables

and basic interviewing techniques (Dagley, 1972). Relationship

variables are abilities in creating the facilitative relationship

characterized by empathy, genuineness, warmth, and respect toward the

client. These are often revealed through technical interviewing

skills where attempts atmeasures have met with varying degrees of










success (Blaas & Heck, 1975). A high degree of skill in basic

techniques is deemed necessary such that considerable attention in

training programs is given to developing skills such as reflection,

clarification, use of silence, exploration, structuring, goal

setting, summarization, interpretation, confrontation, and appro-

priate use of non-verbal behavior and behavioral techniques, such

as reinforcement, modeling, behavior rehearsal, conditioning, and

desensitization (Dagley, 1972). Knowledge of other factors basic

to the relationship are also considered important. Counselors should

show knowledge of the effects of variables such as individuality,

defense mechanisms, expectations, and setting and situational variables

which impact on the counseling relationship.

Another area of high concentration in counseling is the theoreti-

cal approaches to the counseling process. Much attention has been

given to knowledge of various theoretical orientations of personality

development and corresponding therapeutic intervention methods.

Counselors are generally expected to be knowledgeable about several

major therapeutic approaches, their philosophical tenets, and rela-

tively skilled in the use of techniques of a few (Frey & Raming, 1979).

Recently, authors have been concerned about the overemphasis on

therapeutic approaches and suggest that counselors should be knowledge-

able about development approaches as well (Blocher, 1966; Forster,

1978). Knowledge of theoretical approaches to counseling should

include theories covering family intervention (Minuchin, 1974), group

counseling (Lechowicz & Gazda, 1975), and agency or community inter-

vention (Neil, 1976).










In recent years greater attention has been given to supervision

in counseling. As the paraprofessional movement grows, professional

counselors spend more time supervising subordinates. Supervisory

skills have thus been advocated for counselors (Chiko et al., 1980).

In addition, the evidence indicates that counselor skill levels

decrease over time although not quite to pre-training levels (Meyer,

1978). Maintenance of counselor skills is more probable if the

counselor has knowledge of self-supervision methods (Meyer, 1978;

Spooner & Stone, 1977).

Counselors should have an adequate foundation in research methods

in order to discriminate good from poor in reading the literature,

be able to design research studies, and report research results

(McPheeters, 1979). Assessment is an area which, like research, has

been seen as important to counselors for many years. Counselors are

expected to be knowledgeable of a variety of assessment procedures

and instruments for individuals, groups, organizations, and communities

(Neil, 1976). Two newer areas of emphasis are program development and

evaluation. Program development is also used for a variety of client

types and includes goal setting, planning, administrative, and

organizing activities (Chiko et al., 1980). Wheeler (1980) has spoken

to the increasing need of counselors for knowledge of methods and

procedures for evaluation. Such evaluation knowledge should be

adaptable to several situations, conditions, and content elements;

and, therefore, familiarity with several evaluation models is advised

(Neil, 1976; Wheeler, 1980).









Three areas of function that require specialized counselor

knowledge and ability are career guidance,.sex therapy, and consulta-

tion. Career guidance is to a great degree the foundation of

counseling and its' effect on personal well-being has been proved

repeatedly (Super, 1955). Counselors should have knowledge of career

development, career choice theories, and career information resources.

The counselor must be able to assist an individual in systematically

assessing his or her talents and vocational qualities, investigating

and discovering career alternatives, and making decisions that lead

to action in the career arena (Mitchell, 1975). Sex therapy is an

area of counseling which has become more important in recent years.

Kirkpatrick (1980) surveyed the knowledge needs of counselors with

respect to human sexuality and derived 20 knowledge and ability state-

ments that are important for the counselor. They emphasize the counselors

need to be able to discuss sexual problems of clients on a par with

other kinds of client concerns and be able to provide needed information.

Other professions and the public at large are discovering that counselors

have an important and useful body of information (Barnick & O'Brien,

1980). Via consultation, counselors have the opportunity to affect

large numbers of people and provide effective preventive mental health

measures. Knowledge of consultation models and processes are a

necessary part of the counselor's repertoire (Dagley, 1972). Related

to consultation, knowledge and skills in the area of teaching and

learning models are also cited as valuable to counselors (Chiko et al.,

1980).









Two other skill areas are evident in the literature as important

to counselors. Referral skills are vital .to the professional

counselor and include the recognition of one's limitations, knowledge

of available resources, and the ability to make the transfer of a

client.without threatening the client's self-esteem or commitment to

seek help (Dagley, 1972). The other skill area is leisure counseling.

As the time and effort required by the career arena is reduced in a

modern world, the skills involved in assisting clients in appraising

and selecting appropriate and fulfilling leisure activities.are seen

as more important (Corley & Johnson, 1979).

Knowledge in other areas has been cited as important to counselors

as well. Arredondo-Dowd and Gonsalves (1980) have identified

competencies recommended for the culturally effective counselor.

Knowledge of the needs of minorities and other special groups,

including veterans, women, the handicapped, youth, and older persons,

are seen as valuable (Chiko et al., 1980). Information on the use of

drugs (psychoactive, pharmaceutical, and illicit), alcohol, and the

effects of long-term use of both is increasingly important to

counselors, especially in the clinical setting (Roy Littlejohn

Associates, 1974; Steinberg et al., 1976a, 1976b). Counselors must

be aware of the ethical standards that govern the profession,

especially those pertaining to client confidentiality, intervention

processes, professional conduct, and test usage. In addition, it is

important to know state laws governing privileged communication, case

records, privacy and credentialing (Dagley, 1972).









Specific areas of counselor competency and the knowledge,

skills, and abilities of each used in the construction of instru-

ments for the current study are discussed in greater detail in

Chapter III and the Appendices.

To be useful, knowledge, skills, and abilities in the literature

must be systematized and field-tested. The technique used must allow

addition of competencies or competency components by professionals in

the field. The Delphi technique has been employed in recent years to

identify competencies for counselor education and certification

(Fuller, 1975; Hanson, 1977; Lechowicz & Gazda, 1975; Newton &

Richardson, 1976).


Delphi Technique

In the technological age, decision-making difficulty is enhanced

by the complexity of issues and by the far reaching effect of decision

consequences. It is because of this complexity that a need existed

for a method of study that allowed for the most comprehensive input

available for issue review, decision-making, and future forecasting.

It was to meet this need that the Delphi Technique was developed.

Because of its potential for large scale problem solving, the Delphi

Technique has experienced tremendous use in the past decade. In

critiquing the method, Hill and Fowles (1975) have said, "no other

forecasting method is so conspicuously a fixture of the contemporary

effort to get prediction onto a scientific basis" (p. 179). While

critics question the scientific strength of Delphi uses to date, they

do not deny that it has in recent years become a very important tool










in the effort to refine and systematize goal setting and forecasting

in a large number of disciplines.


Types of Delphi Studies

The development of the technique began at the Rand Corporation

in the early fifties. An Air Force sponsored "Project Delphi" used

expert opinions to assess prime United States targets for hypothetical

Soviet missile attacks. Because of the nature of the project, the

result was classified as a secret document. It was not until 1964

that the first Delphi study outside the defense department appeared

as a Rand paper entitled "Report on Long-Range Forecasting Study" by

Gordan and Helmer (Linstone & Turoff, 1975). From this beginning,

the Delphi grew rapidly in adaptation and applications. Its use

in forecasting and goal-setting has been demonstrated in various

countries around the globe, as well as in government, industry,

and academics (Linstone & Turoff, 1975; see also extensive biblio-

graphies in Linstone & Turoff, 1975; Sackman, 1975; Weaver, 1972).

Weaver (1972) identified two types of Delphi studies: the

exploratory study.and the normative study. There are fundamental

differences which effect the relative strengths and limitations of

each. The exploratory study is used to question experts on their

views about a chronology of scientific and technological events and

to collect their judgments as to just when the events might occur.

The data from these studies are in the form of numeric probability

dates. Conversely, the normative study focuses on what is desirable

in the form of goals and priorities. The normative study differs

from the exploratory type in two ways: (a) the result is a desirable









product as opposed to a probable outcome, and (b) the concern is with

priorities instead of specific dates. The main function of both,

however, is opinion sharing through feedback (Weaver, 1972). Another

type, identified by Strauss and Zeigler (1975), who called the first

two numeric and policy, added historic as a type of Delphi study

used to explain the range of issues that foster a specific decision

or the identification of the range of possible alternatives that

could have been posed against a certain past decision.

The developers of the Delphi technique denote three quint-

essential attributes that contribute to authentic consensus and

valid results: anonymity of panelists, statistical response, and

interactive polling with feedback (Sackman, 1975). The result of

any Delphi study should be the presentation of observed expert

concurrence in a given application area where none existed previously.

This assumes that panelists are experts and consensus is obtained

through reliable and valid procedure (Sackman, 1975). This procedure

includes not only the Delphi technique but also procedures that

facilitate reliability in any questionnaire survey.

Methods and Goals

In the Delphi Technique a panel is selected and polled on a

problem of interest. The panelists remain anonymous to one another

(Dodge & Clark, 1977). In the initial studies, panelists were paid

experts and the panel size was about the same as a conference committee

or small group (Sackman, 1975). More recently, the selection of

experts has been unpaid knowledgeable persons with a vested interest

in the outcome of the study; panels have increased in size for increased









diversity of opinion and quantity of input (Huckfeldt & Judd,

1974).

Responses to the first poll are collected and feedback of the

results accompanies the second round. Each panelist has an

opportunity to review each response in the light of feedback from

the previous round. The panelists will then respond to the current

round by repeating or modifying previous responses. This process

is continued until opinions stabilize. Consensus should emerge over

rounds as panelists are presented information on the opinions of the

entire panel. This consensus is unaffected by the status or personal

persuasion of any individual panel member and ideally represents the

best collective judgment of the group (Dodge & Clark, 1977).

While consensus of panel opinion regarding the area under

question is usually the primary goal of a Delphi study, there are

secondary goals, any or all of which may be incorporated within any

Delphi study. They are

1. explore or expose underlying assumptions or information

leading to differing judgments;

2. seek out information which may generate a consensus of

judgment on the part of the respondent group;

3. correlate informed judgments on topics spanning a wide
range of disciplines; and

4. educate the respondent group as to the diverse and inter-

related aspects of the topic (Strauss & Zeigler, 1975).

These goals, both primary and secondary, rest squarely on two

assumptions that are the underlayment of the Delphi technique. First,









if participants agree and, by agreeing, move to a central position

or consensus, the resulting data are assumed to be more believable.

Second, anonymous responses, such as those generated by Delohi, are

more likely to lead to reasonable and objective input than are the

activities of interpersonal conferencing (Rasp, 1973).


Delphi Uses

It is obvious that the Delphi method of experimentation is not

appropriate for all survey applications. The Delphi technique is a

method of structuring the collective judgments of a group in order to

deal with a complex problem. It should be used in situations that are

not conducive to precise analytical solutions, or when participation

is required by groups that cannot meet face to face (Dodge & Clark,

1977). The Delphi technique has been used in almost every field

where future developments have impact. Beginning in military

technology, the Delphi uses rapidly spread to industry where it has

been used in analyzing new product lines and predicting likely

inventions and new technologies. Uses in government have been many,

including land use policy formation and information systems relative

to development planning. It has been employed in health care programs

for problem identification, priority setting, and problem solving

(Tersine & Riggs, 1976).

Education is an area in which the Delphi technique has had

extensive use. Its use has included formulation of educational goals

and objectives, curriculum and campus planning, and development of

evaluation criteria (Dodge & Clark, 1977; Judd, 1972), as well as a

tool for creating model educational systems (Dodge & Clark, 1977).










Its application in education has had three styles: (a) as a method

for studying the process of thinking about the future, (b) as a

pedagogical tool forcing people to think in complex ways about the

future, and (c) as a planning tool to aid in probing priorities

held by members and constituencies of an organization (Judd, 1972).

Delphi use in education typically has been of the normative or

policy type with some attention to the exploratory (numeric) and

historical types. Uses outside education have been mostly exploratory

(Sackman, 1975).

Sackman (1975), a Delphi critic and Rand researcher, indicates

that a large and growing roster of firms are using Delphi for diverse

purposes and that these applications, broadly considered, are virtually

indistinguishable from the questionnaire technique. Advocates, such

as Turoff have expanded the scope of Delphi as a general purpose

vehicle for communication and consensus of widely distributed popula-

tions and for group problem solving (Linstone & Turoff, 1975). The

Delphi technique has been advanced at an increasing.rate into the

general field of questionnaire design and development, not only for

experts but for non-experts (Sackman, 1975).

The Policy Delphi, which generates verbal data, is commonly used

to supplement or stimulate the committee approach to problem solving

(Strauss & Zeigler, 1975). It is the Delphi form which encourages

communication of issues related to items in the areas of study. The

suggested procedure for formulation has three important steps:

(a) the monitor devotes considerable time to developing the initial

round to cover obvious issues; (b) he should seed the list with an










initial range of options, but allow for the respondents to add;

and (c) he should ask for positions on items and underlying

assumptions in the first round (Linstone & Turoff, 1975). The

purpose is not only to obtain consensus, but also to establish all

the differing positions advocated and principal pro and con arguments

for the positions (Strauss & Zeigler, 1975). The policy type Delphi

allows the utilization of larger numbers of people than a committee

approach to problem-solving. In some cases, a small committee can

use the results to formulate needed policy and in this way the

Delphi acts as a precursor to committee work (Strauss & Zeigler,

1975). Rasp (1974) cites three strengths in using the Delphi method

for policy formation. First, whole communities of people who will be

effected by the decision are involved in the process. Second, the

method requires participants to consider basic issues and make clear

statements of their viewpoints concerning them. Third, the pool of

resultant data is an invaluable ground of information on which action

decisions can be made.

Delphi Advantages and Weaknesses

Advantages of Delphi use in long-range planning have been

addressed by several writers and critics (Linstone & Turoff, 1975;

Rasp, 1974; Sackman, 1975; Weaver, 1972), but the most comprehensive

listing is that of Tersine and Riggs (1976). They discuss a number

of interrelated advantages that the Delphi technique offers. Control

of interaction is a direct attempt to avoid the disadvantages of

conventional use of experts via round table discussions, conferences,

and committees. The fact that experts are not identified receives










credit for greater flow of ideas, fuller participation of respondents,

and increased evidence of problem closure. Also, participants have

no ego involvement and find it easier to change their minds instead

of defending an original estimate which appears false in the light of

new information. Participants are not susceptible to the halo effect

of a panelist's rank or expertise, and a band wagon effect is reduced

because of the absence of persuasion. Consensus is formed and

significant deviation is justified. Panelists can be geographically

dispersed and the panel is not restricted in size or by demands on

panel members. Finally, the Delphi technique encourages individual

thinking that focuses on issues rather than being side tracked by

superfluous arguments.

While the advantages of Delphi method over other group fore-

casting and decision-making procedures are attractive, critics of

the method point out that it has unproven assumptions. Since there

has been very little empirical research done to validate the Delphi

procedure, there is little exact data on the procedural strengths and

weaknesses. There have been several questions raised about Delphi

technique and its vulnerability to validity threats (Dodge & Clark,

1977). These questions provide some guides for avoiding the pitfalls

of some past Delphi studies (Sackman, 1975).

Criticism of the Delphi technique is best reviewed in two

dimensions: potential threats to reliability and potential threats

to validity. Reliability is defined as the precision of measurement

or dependability of measures across replication. It can be tested by

varying internal procedures and studying the effects on results;










however, most Delphi studies have been concerned principally with

the content of the study and have not advanced the Delphi method

by reliability testing (Hill & Fowles, 1975). The first reliability

issue addressed by most critics is the choice of respondents and the

effect of the choice on the results of Delphi studies. An immediate

problem is that of defining "expert" and selecting individual experts

(Hill & Fowles, 1975). The first question is, "Are experts necessary?"

Some studies show no significant differences between expert and non-

expert judgments in Delphi studies of value-laden and non-technical

subjects (Welty, 1973). Sackman (1975) suggests that the concept

of expert is virtually meaningless in experiments of complex social

phenomena. Further, he states that there exists an uncontrolled and

unknown expert halo effect in Delphi method which contributes to

expert oversell. It has been observed (Hill & Fowles, 1975) that

no study has reported systematic efforts to attain representative

samples from a defined universe of experts and that this is crucial

where the discipline in question may contain divergent schools of

thought. Another problem in the use of experts is differentiating

between levels of expertise. This has been tested twice by self-

assessment and produced non-significant results (Welty, 1973). Also

of concern to critics is the attitude of participants to the Delphi

technique (Hill & Fowles, 1975) which could contribute to the large

problem of panel attrition. Panel attrition is described as a major

issue in large scale Delphi studies (Huckfeldt & Judd, 1974); the

danger is that results are based on an unrepresentative subset of

the original panel and population. This becomes a self-selection

bias (Hill & Fowles, 1975).










A second issue of reliability is in the character of the first

round. The first Delphi questionnaire can draft statements from

experts or present a pre-selected set of statements. Criticism of

the second approach is that it robs the Delphi of half of its expert

function and that if experts exist in an area they should be

relied upon to initiate statements (Hill & Fowles, 1975). Uhl (in

Judd, 1972) defends the use of pre-selected items for the first round

of Delphi because of four advantages. First, there is time saved

that would be needed to collate and edit the usual round one responses

and prepare output that becomes round two. Second, where participants

are not experts, important statements are likely to be omitted.

Third, some respondents appreciate a completed instrument. Fourth,

greater percentages of respondents are lost in the first round in

conventional Delphi open questions (Judd, 1972).

There are issues common to most questionnaire surveys which are

important to Delphi technique as well. Mail-out and mail-in question-

naires have reliability pitfalls since some participants consider the

task too burdensome or give only cursory attention to answering; also,

panelists have no way to resolve ambiguous questions (Hill & Fowles,

1975). Clarity of questions or statements in Delphi studies is

important in preventing distortion of results. The only reported

examination of the reliability threat of ambiguity was based on word

length, which is not necessarily synonymous with ambiguity, and offers

no useful suggestions for methodological improvement (Hill & Fowles,

1975).










Fatigue caused by length and difficulty of Delphi questionnaires

is often blamed for high attrition rates reported in large scale

studies (Dodge & Clark, 1977). This fatigue can effect the result

of a study showing differences from first page to last (Huckfeldt &

Judd, 1974). In one study, fatigue effect was tested by varying the

order of pages of a questionnaire for subgroups of a panel. There

were no significant differences (Dodge & Clark, 1977). While low

response rates are typical of all mail questionnaires, Delphi

experimenters do not make adequate use of subsequent mailing between

round to boost the total response rate to acceptable levels (Hill &

Fowles, 1975). Huckfeldt and Judd (1974) cite three other influences

thought to counter high attrition. Panel members should be asked

to commit themselves to the study. They should be told from the

start about panel anonymity during the study. Later round question-

naires should be personalized to the extent that previous round

responses are indicated for each participant.

The last of Delphi reliability issues relates to the nature of

consensus. While some studies have been unclear as to how consensus

was derived, most seem to use simple and uniformly applied standards.

This is rather arbitrary and the question remains as to how much

consensus is enough. Hill and Fowles (1975) suggest that either a

theory-based or statistically derived standard for assessing

consensus would be more powerful. They also note that development

of a statistical criterion would require more attention to the random

selection of panel members, panel size, and minimization of attrition;

but it would allow for measurement of significance.









There are two ways to view issues of validity of forecasting

Delphi studies. One is data validity, and the other is method

validity. Method validity is a question of whether the. design

allows the kind of results it intends. Delphi method narrows

concerns from a universe of phenomena to a well defined topic; from

a population of knowledgeable persons to a select group of specialists;

questions that do not lead to consensus are often dropped. The result

of this condensation may be false prediction (Hill & Fowles, 1975).

Related to this is the problem that the area of study is often

established minus its cultural context and minus the external forces

that impinge upon it, thus slighting the wider context. This can be

a major design flaw (Hill & Fowles, 1975).

Data validity refers to the accuracy of Delphi forecase results.

It is affected by most of the reliability threats discussed pre-

viously. Two validation studies have been done with Delphi technique.

One testing Delphi short-range prediction against actual occurrence

found the Delphi successful in predicting 32 out of 40 events. In

another test against conventional group methods, Delphi was more

accurate in 13 of 16 cases, less in two cases, and equal in one

(Tersine & Riggs, 1976).

Choice of respondents can effect data validity. Experts may be

too homogeneous to reflect adequately differing points of view

(Hill & Fowles, 1975). Weaver (1972) identifies this weakness in

educational Delphi studies as a contributor to "establishment futur-

ology" which does not take into account influence on the future by

radical elements of society.










Weaver (1972) discusses one other threat to data validity in

Delphi technique. He implies that using a questionnaire technique

to generate feedback does not eliminate the effects on conformity

that are observed under group pressure. Those persons who tend to

conform under group pressure do so even when the norm which attracts

them is the statistical averaging of opinions from a questionnaire.

Furthermore, the conformist (in both conditions) tends to be more

submissive, more anxious, more authoritarian, less intellectual, less

theoretical, less realistic, and more emotionally reactive. There

may be artificial concurrence due to laziness or concurrence in the

interest of harmony rather than in the interest of accuracy (Hill &

Fowles, 1975).

It is clear that the Delphi technique is as complex as the

subjects it is used to examine. Without the benefit of specific

theoretical guidelines for Delphi technique, it is important that

Delphi researchers utilize past studies and criticisms in an effort

to strengthen the design of future studies. Simultaneously, Delphi

researchers should attempt to advance knowledge about the technique

by making study adaptation that lends reliability and validity data.

In this way guidelines can be developed for future Delphi uses.



Summary

The literature in this chapter has been used to describe

several important aspects of information that relate to the present

study. It has described the factors that contributed to the emergence

of Mental Health Counseling as a profession and the body of knowledge






90


thought by many to be necessary for adequate performance in the

profession. The chapter has presented the reasons for choice of

credentialing procedures to be pursued by the profession and why

credentialing must be based on competencies. Since competencies

must be constructed from identified knowledge, skills, and abilities,

an appropriate method for establishing these elements was reviewed.

The following chapter explains the method employed in field testing

knowledge, skills, and abilities found in the literature and

exploring new ideas to establish a performance base for mental

health counselors.




University of Florida Home Page
© 2004 - 2010 University of Florida George A. Smathers Libraries.
All rights reserved.

Acceptable Use, Copyright, and Disclaimer Statement
Last updated October 10, 2010 - Version 2.9.7 - mvs