Mental Health Counseling: Integrating Consultation

Abstract With the meshing of consultation and advocacy, mental health counselors can both assist in dealing with the issues that their clients face personally, but also help to make better the world around them. In order to respond to the thesis questions presented in this paper, we must first define consultation and social justice advocacy within the counseling context. Typically, consultation means a general meeting or conference between parties.

In the counseling context however, we can say that it “usually involves three parties: a consultant, a consultee, and a client system. The consultant delivers direct service to the consultee, who delivers direct service to a client system" (Doherty, 1990). Consultation for professional counselors typically involves acting on behalf of an identified client (or student) through interaction with another professional consultee or other stakeholder in the client’s welfare (Brown, Pryzwansky, & Schulte, 2010; Kampwirth, 2006; Kurpius & Fuqua, 1993).

The consultee may also be conceptualized as a system or organization that serves an identified client or student population (Brown et al. , 2010; Moe & Perera-Diltz, 2009). With these definitions, a counseling consultant relationship could be thought of as a chain of assistance in dealing with client issues. Advocacy, typically in regards to social justice, is a way in which a change is brought into society. In a historical context, the mental health reforms that Clifford Beers brought about in the late 1800s were an impactful form of social advocacy.

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Beers launched one of the earliest client-advocate health reform movements in the United States. A former patient who was institutionalized for three years, Beers led national and international efforts to improve institutional care, challenge the stigma of mental illness, and promote mental health. His efforts resulted in a major shift in attitudes toward mental illness, as well as the introduction of guidance counselors in US schools and the inclusion of evidence of a defendant's psychological state in law courts (Parry, 2010).

Consultation and social justice advocacy may not be exactly similar, but they can be used as cohesive tools that counselors use in order to help their clients. Though scholars continue to identify concerns regarding how the specific nature and scope of social justice advocacy for counselors will be defined (Nelson-Jones, 2002; Roysircar, 2009; Weinrach & Thomas, 2004), in 2003 the American Counseling Association (ACA) endorsed the creation and publication of the Advocacy Competencies (Lewis et al. , 2003) for professional counselors.

Along with the publication of this special issue, scholarship has focused on making the case for social justice (Prilletensky & Prilletensky, 2003; Vera & Speight, 2003), and on synthesizing the social justice counseling paradigm with other key counseling perspectives such as multicultural theory (Constantine et al. , 2007; Crethar et al. , 2008) and school counseling (Bemak & Chung, 2008; Dahir & Stone, 2009). The idea of meshing consultation with social advocacy is prudent because we as counselors should work not only to better the lives of our clients but of the world around them.

There seems to be an obvious association with mental health and the groups to which social justice advocacy is most needed. Negative experiences of historically marginalized groups can lead to psychological dysfunction and an overall decline in mental health (Chang, Hays, & Milliken, 2009). The American Counseling Association’s Code of Ethics states that counselors should “recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and the role of mental health professionals in perpetuating these prejudices through diagnosis and treatment. The need for counselors to integrate social justice advocacy with consultation stems from the fact that much of the clientele that is seeking out mental health services have suffered in some form or another from social injustice(s). It is imperative in cases like this that a balance is made between providing both consultation and advocacy to our clients. In working with populations that have experienced social injustices such as poverty, racial intimidations, abuse, etc. t is the responsibility of the counselor to be the voice for those who cannot speak up for themselves. Practices such as collaborating with multiple stakeholder groups and identifying institutional polices that may promote marginalization of vulnerable community members are used by both consultants (Brown, 1993; Kampwirth, 2006) and advocates (Vera & Speight, 2003). While it is important to understand the social injustices that many clients face, it is also critical to know exactly why these injustices occur.

It is also important that counselors attempt to change the structures that are responsible for the oppression of mental health clients. This social justice movement is sometimes referred to as professional counseling’s fifth force (Ratts, D’Andrea, & Arredondo, 2004)—in other words advocacy counseling. Counseling is indeed an effective and powerful tool in helping the less fortunate with their problems. However, counseling by itself is cannot be used to advance clients’ wellbeing. There must be an interlocking of counseling, consultation and social advocacy.

That is, the oppressed clientele would greatly benefit from outside consultants that have the capability of promoting change within the corrosive environments in which they live. Authors Ratts and Hutchins (2009) have also highlighted how counselors-as advocates often adopt the role of consultant to promote empowerment of clients and students (Moe, Perera-Diltz, Sepulveda, 2010). Advocacy can play an important role in many aspects of alleviating the plight of the oppressed population of mental health clients.

For example, advocacy can assist in supporting equitable access to needed medical services. It can also help to reduce the discrimination experienced by consumers within the health care system by facilitating communication with health care providers and by addressing any prejudicial beliefs health care providers may hold. Finally, advocates can assist consumers in addressing any discrimination that they may experience within the health care system (Stylianos & Kehyayan, 2012).

If not for the advocacy of interest groups, doctors, nurses, patients, politicians, etc. the recent healthcare system changes may never have been signed into law which would have left millions still without access to affordable healthcare coverage or being denied access for discriminatory reasons. If a client does not have health insurance or the means to pay for services, a consultant could be utilized as a third party source in order to help the client have access to mental health services.

Consultants in this situation could range from a social worker, a career counselor or welfare office. The importance of children’s mental health in early development has long been documented, and many advocates have made impassioned pleas for additional resources for both children and their parents during the early years. A hypothetical program in which a mental health counselor could serve both as a consultant and an advocate would be to have counselors readily available to under privileged pre-school children in an outside child-care setting.

The counselors could serve as a means of providing intervention of serious future problems that these children may have as they mature. These counselors can also help teachers and parents deal with issues of challenging behavior or even learning disabilities. The function of a mental health counselor that is serving as a consultant in this type of surrounding would be very different than they typical one-to-one therapy that usually occurs between counselor and client.

The role of a consultant in this sort of program would be to work as a team with a child-care center staff to recognize and deal with difficult behaviors and/or learning behaviors successfully. They would also serve as coach or mentor to families dealing with challenging issues at home and could help them access quality behavioral health services outside of the pre-school setting. In regards to social advocacy in this hypothetical program, emphasis can be made on the lack of healthcare afforded to children. According to a report from the U.

S. Surgeon General, current estimates of children that are not being provided health care services are vast: “one in five children is estimated to have a mental health problem that impairs functioning, while less than half of all children and one third of adults with a diagnosable mental disorder receive any kind of services”. Inadequate finances from families of mentally ill children can be a main reason that children go without quality mental health services. Another cause can be attributed to the stigma surrounding mental illness.

This can ring exceptionally true among low-income families and minorities. To erase this type of stigma, it may be helpful for a mental health consultant in this type of program to ease into the role of therapist as one-to-one counseling may be too overwhelming for those who come into the process with a set of preconceived beliefs. They could offer classes on how to deal with a child’s difficult behavior or problem specific support groups such as a group for single parents learning to deal with their child’s emotions.

The job of a mental health counselor is rewarding in that it offers scores of opportunities to impact the lives of others, not just through one-to-one counseling but also through being the voice of the less fortunate through consultation and advocacy. A dedicated counselor should not only provide a sympathetic ear for a client to speak to, but should also take advantage of their power to promote real change for those who really need it.

By incorporating both consultation and advocacy into a counselor’s course of action into the treatment plans of their clients, both counselor and client will build an even stronger rapport than thought possible. References Bemak, F. , & Chi-Yi Chung, R. (2008). New professional roles and advocacy strategies for school counselors: A multicultural/social justice perspective to move beyond the nice counselor syndrome. Journal of Counseling & Development, 86, 372-381. Brown, D. , Pryzwansky, W. , & Schulte, A. (2010).

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