Abnormal Behavior

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©2017 Cengage Learning. All rights reserved.

Understanding and Treating Mental Disorders

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©2017 Cengage Learning. All rights reserved.

AMHCA Standards for the
Practice of Clinical Mental
Health Counseling
Adopted 1979
Revised 1992, 1993, 1999, 2003, 2011, 2015, 2016, 2017,
and 2018

I. Introduction……………………………………………………………………………………………..1
A. Scope of Practice………………………………………………………………………………..2
B. Standards of Practice and Research……………………………………………………..3

II. Educational and Pre-degree Clinical Training Standards………………………..4
A. Program……………………………………………………………………………………………….4
B. Curriculum…………………………………………………………………………………………..4
C. Specialized Clinical Mental Health Counseling Training………………………5
D. Pre-degree Clinical Mental Health Counseling Field Work
Guidelines……………………………………………………………………………………………….5

III. Faculty and Supervisor Standards………………………………………………………….6
A. Faculty Standards…………………………………………………………………………………6
B. Supervisor Standards……………………………………………………………………………8

IV. Clinical Practice Standards……………………………………………………………………11
A. Post-degree/Pre-licensure………………………………………………………………….11
B. Peer Review and Supervision……………………………………………………………..11
C. Continuing Education………………………………………………………………………..11
D. Legal and Ethical Issues…………………………………………………………………….12

V. Recommend AMHCA Training…………………………………………………………….13
A. Biological Bases of Behavior……………………………………………………………..14
B. Specialized Clinical Assessment………………………………………………………….19
C. Trauma Informed Care……………………………………………………………………..21
D. Substance Use Disorders and Co-occurring Disorders…………………….27
E. Technology Assisted Counseling (TAC) …………………………………………..32
F. Integrated Behavioral Health Care Counseling…………………………..38
G. Aging and Older Adults Standards and Competencies………………………44
H. Child and Adolescent Standards and Competencies………………………….47

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 1

I. Introduction
Since its formation as a professional organization in 1976, the
American Mental Health Counselors Association, AMHCA, has
been committed to establishing and promoting vigorous standards
for education and training, professional practice, and professional
ethics for clinical mental health counselors. Initially, AMHCA sought
to define and promote the professional identity of mental health
counselors. Today, with licensure laws in all 50 states, AMHCA
strives to enhance the practice of clinical mental health counseling
and to promote standards for clinical education and clinical practice
that anticipate the future roles of clinical mental health counselors
within the broader health care system. As a professional association,
AMHCA affiliated with APGA (a precursor to the American
Counseling Association [ACA]) as a division in 1978; in 1998,
AMHCA became a separate not- for-profit organization, but retained
its status as a division of ACA.

In 1976, a group of community mental health, community
agency and private practice counselors founded AMHCA as the
professional association for the newly emerging group of counselors
who identified their practice as “mental health counseling.” Without
credentialing, licensure, education and training standards, or other
marks of a clinical profession, these early mental health counselors
worked alongside social workers and psychologists in the developing
community mental health service system as “paraprofessionals” or
“allied health professionals” despite the fact that they held master’s
or doctoral degrees. By 1979, the early founders of AMHCA
had organized four key mechanisms for defining the new clinical
professional specialty:

1) identifying a definition of mental health counseling;
2) setting standards for education and training, clinical practice,
and professional ethics;
3) creating a national credentialing system; and
4) starting a professional journal, which included research and
clinical practice content.

These mechanisms have significantly contributed to the professional
development of clinical mental health counseling and merit further
explication.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 2

A. Scope of Practice
A crucial development in mental health counseling has been
defining the roles and functions of the profession. The initial
issue of AMHCA’s Journal of Mental Health Counseling included
the first published definition of mental health counseling as
“an interdisciplinary, multifaceted, holistic process of: 1) the
promotion of healthy lifestyles; 2) identification of individual
stressors and personal levels of functioning; and 3) the preservation
or restoration of mental health” (Seiler & Messina, 1979). In
1986, the AMHCA Board of Directors adopted a more formal,
comprehensive definition: “clinical mental health counseling is
the provision of professional counseling services involving the
application of principles of psychotherapy, human development,
learning theory, group dynamics, and the etiology of mental
illness and dysfunctional behavior to individuals, couples,
families and groups, for the purpose of promoting optimal
mental health, dealing with normal problems of living and
treating psychopathology. The practice of clinical mental health
counseling includes, but is not limited to, diagnosis and treatment
of mental and emotional disorders, psycho- educational techniques
aimed at the prevention of mental and emotional disorders,
consultations to individuals, couples, families, groups, organizations
and communities, and clinical research into more effective
psychotherapeutic treatment modalities.”

Clinical mental health counselors have always understood that
their professional work encompasses a broad range of clinical
practice, including dealing with normal problems of living and
promoting optimal mental health in addition to the prevention,
intervention and treatment of mental and emotional disorders.
This work of clinical mental health counselors serves the needs
of socially and culturally diverse clients (e.g. age, gender, race/
ethnicity, socio- economic status, sexual orientation, etc.) across
the lifespan (i.e. children, adolescents and adults including
older adults and geriatric populations). Clinical mental health
counselors have developed a strong sense of professional
identity since 1976. AMHCA has sought to support this sense of
professional identity through legislative and professional advocacy,

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 3

professional standards, a code of ethics, continuing education,
and clinical educational resources, and support for evidence-
based best practices, research and peer-reviewed dissemination of
developments in the field.

B. Standards of Practice and Research
A key development for the profession was AMHCA’s creation of
education and training standards for mental health counselors in
1979. The Council for Accreditation of Counseling and Related
Educational Programs (CACREP) adopted and adapted these
AMHCA training standards in 1988 when it established the first
set of accreditation standards for master’s programs in clinical
mental health counseling. In keeping with AMHCA standards,
CACREP accreditation standards for the mental health counseling
specialty have consistently required 60 semester hours of graduate
coursework. AMHCA remained an active advocate for vigorous
clinical training standards through the 2009 CACREP accreditation
standards revision process, during which community counseling
accreditation standards were merged into the new clinical mental
health counseling standards. After careful review, AMHCA
endorsed the clinical mental health counseling standards.

Another important step in the further professionalization
of clinical mental health counseling, AMHCA established the
National Academy of Certified Mental Health Counselors, the
first credentialing body for clinical mental health counselors,
and gave its first certification examination in 1979. In 1993, this
certified clinical mental health counselor credential (CCMHC)
was transferred to the National Board for Certified Counselors
(NBCC). NBCC provides the Board Certification fo CCMHCs.
AMHCA clinical standards have always recognized and
incorporated the CCMHC credential as an important means
of recognizing that a clinical mental health counselor has met
independent clinical practice standards, despite significant
differences that exist among state counselor licensure laws, as well
as among educational and training programs.

Finally, since 1979, AMHCA published the Journal of Mental
Health Counseling, which has become widely recognized and cited

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 4

as an important contributor to the research and professional
literature on clinical mental health counseling.

Taken together, these four mechanisms (definition of scope
of practice; educational and training standards, professional
practice standards and code of ethics; credentialing; and
professional journal) resulted in the recognition of clinical mental
health counseling as an important profession to be included in
our health care system. In recognition of the central importance
of vigorous professional educational and clinical practice
standards, AMHCA has periodically revised its professional
standards in 1993- 94, 1999, 2003, and 2010- 11 to reflect evolving
practice requirements. These professional standards, as well as
the 2015 AMHCA Code of Ethics, constitute the basis from which
AMHCA continues to advocate for, and seek to advance, the
practice of clinical mental health counseling.

II. Educational and Pre- degree Clinical Training Standards
Required Education: Master’s in Clinical Mental Health Counseling
(60 semester hours)

A. Program
CACREP- accredited clinical mental health counseling program –
based on 2009 standards (endorsed by AMHCA Board) or master’s
degree in counseling (minimum of 48 semester hours) from a
regionally accredited institution. The 48 semester- hour minimum
will increase to 60 semester hours in January 2016.

B. Curriculum
Consistent with 2009 CACREP standards, clinical mental health
counseling programs should include the core CACREP areas and
specialized training in clinical mental health counseling. The core
CACREP areas include:

• Professional Orientation and Ethical Practice;
• Social and Cultural Diversity;
• Human Growth and Development across the lifespan;
• Career Development;
• Counseling theories and Helping Relationships;
• Group Work;

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 5

• Assessment;
• Research and Program Evaluation.

C. Specialized Clinical Mental Health Counseling Training:
These areas of Clinical mental health counselor preparation
address the clinical mental health needs across the lifespan
(children, adolescents, adults and older adults) and across socially
and culturally diverse populations:

• Ethical, Legal and Practice Foundations of Clinical Mental
Health Counseling;

• Prevention and Clinical Intervention;
• Clinical Assessment;
• Diagnosis and Treatment of Mental Disorders;
• Diversity and Advocacy in Clinical Mental Health

Counseling; and
• Clinical Mental Health Counseling Research and Outcome

Evaluation.
AMHCA recommends additional training in Clinical Mental

Health Counseling described in the following standards:
• Biological Bases of Behavior (including psychopathology

and psychopharmacology);
• Trauma Informed Care and;
• Co- occurring Disorders and Substance Use Disorders (mental

disorders and substance abuse).
This training may be completed as part of the degree program, in
post- master’s coursework, or as part of a certificate or continuing
education or CCMHC credential.

D. Pre- degree Clinical Mental Health Counseling Field Work
Guidelines

• Students’ pre- degree clinical experiences meet the minimum
training standards of 100 Practicum and 600 Internship hours.

• Students receive an hour of clinical supervision by an
independently and approved licensed supervisor for every
20 hours of client direct care. This field work supervision is
in addition to the practicum and internship requirements for
their academic program.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 6

• Students are individually supervised by a supervisor with no
more than 6 (FTE) or 12 total supervisees.

III. Faculty and Supervisor Standards
A. Faculty Standards
Faculty with primary responsibility for clinical mental health
counseling programs should have an earned doctorate in a field
related to clinical mental health counseling and identify with
the field of clinical mental health counseling. While AMHCA
recognizes that clinical mental health counseling programs have
the need for diverse non- primary faculty who may not meet all
of the following criteria, the following knowledge and skills are
required for faculty with primary responsibility for clinical mental
health counseling programs.

1. Knowledge
a. Demonstrate expertise in the content areas in which they teach
and have a thorough understanding of client populations served.

b. Involved in clinical supervision either as instructors or in the
field have a working knowledge of current supervision models
and apply them to the supervisory process.

c. Understand that clinical mental health counselors are asked
to provide a range of services including counseling clients
about problems of living, promoting optimal mental health, and
treatment of mental and emotional disorders across the lifespan.

d. Demonstrate training in the following:
• Evidence- based best practices
• Differential diagnosis and treatment planning
• Co- occurring disorders and substance use disorders
• Trauma, and its related forms (developmental, complex,

situation, chronic or toxic distress, moreal trauma,
historical trauma, etc.)

• Biological bases of behavior including
psychopharmacology

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 7

• Social and cultural foundations of behavior
• Individual family and group counseling
• Clinical assessment and testing
• Professional orientation and ethics
• Advocacy and leadership
• Case consultation and supervision with peers or

specialists, and
• Clinical supervision with a hierarchical or regulatory

supervisor.

e. Possess knowledge about professional boundaries as well
as professional behavior in all interactions with students
and colleagues.

2. Skills
a. Demonstrate clinical mental health skills by completing
licensure requirements including successful completion of
coursework, fieldwork requirements, licensure exams, and
licensure renewal requirements.

b. Demonstrate identification with the field of clinical mental
health counseling by their academic credentials, scholarship
and professional affiliations including their participation in
organizations which promote clinical mental health counseling
including AMHCA, ACA and ACES etc. Faculty who provide
clinical supervision in the program or on site are able to lead
supervision seminars which promote case analysis, small group
process and critical thinking.

c. Complete the equivalent of 15 semester hours of coursework
at the doctoral level in the clinical mental health specialty area or
a comparable amount of scholarship in this area.

d. Possess expertise in working with diverse client populations
in areas they teach including clients across the spectrum of
social class, ethnic/racial groups, lesbian, gay, bisexual and
transgendered communities, etc.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 8

e. Demonstrate and model the ability to develop and maintain
clear role boundaries within the teaching relationship.

f. Demonstrate the ability to analyze and evaluate skills and
performance of students.

B. Supervisor Standards
AMHCA recommends at least 24 continuing education hours or
equivalent graduate credit hours of training in the theory and practice
of clinical supervision for those clinical mental health counselors
who provide pre- or post-degree clinical supervision to CMHC
students or trainees. AMHCA recommends that clinical supervisors
obtain, on the average, at least 3 continuing education hours in
supervision per year as part of their overall program of continuing
education. Clinical supervisors should meet the following knowledge
and skills criteria.

1. Knowledge
a. Possess a strong working knowledge of evidence based and
best practices orientation with clinical theory and interventions
and application to the clinical process.

b. Understand the client population and the practice setting of
the supervisee.

c. Understand and have a working knowledge of current
supervision models and their application to the supervisory
process. Maintain a working knowledge of the most current
methods and techniques in clinical supervision knowledge of
group supervision methodology including the appropriate use
and limits of this modality.

d. Identify and understand the roles, functions and
responsibilities of clinical supervisors including liability in the
supervisory process. Communicates expectations and nature and
extent of the supervision relationship.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 9

e. Maintain a working knowledge of appropriate professional
development activities for supervisees. These activities should be
focused on empirically based scientific knowledge.

f. Show a strong understanding of the supervisory relationship
and related issues, not limited to power differential, evaluation,
parallel process and isomorphic similarities and differences
between supervision and counseling, and qualities that enhance
the supervisor/supervisee working alliance for the benefit of
clients served.

g. Identify and define the cultural issues that arise in clinical
supervision and be able to routinely incorporate cultural
sensitivity into the supervisory process.

h. Understand and define the legal and ethical issues in clinical
supervision including:

• applicable laws, licensure rules and the AMHCA Code of
Ethics specifically as they relate to supervision;

• supervisory liability, respondent superior, and fiduciary
responsibility; and

• risk management models and processes as they relate to
the clinical process and to supervision.

i. Possess a working understanding of the evaluation process
in clinical supervision including evaluating supervisee
competence and remediation of supervisee skill development.
This includes initial, formative and summative assessment of
supervisee knowledge, skills and self- awareness with provisions
for clearly stated expectations, fair delivery of feedback and
due process. Supervision includes both formal and informal
feedback mechanisms.

j. Maintain a working knowledge of industry recognized financial
management processes and required recordkeeping practices
including electronic records and transmission of records

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 10

2. Skills
a. Possess a thorough understanding and experience in working
with the supervisees’ client populations. Be able to demonstrate
and explain the counselor role and appropriate clinical
interventions within the cultural and clinical context.

b. Develop, maintain and explain the supervision contract to
manage supervisee relationships with clear expectations including:
• frequency, location, length and duration of supervision meetings;
• supervision models and expectations of the supervisee and

the supervisor;
• liability and fiduciary responsibility of the supervisor;
• the evaluation process, instruments used and frequency of

evaluation; and
• emergency and critical incident procedures.

c. Demonstrate and model the ability to develop and maintain
clear role boundaries and an appropriate balance between
consultation and training within the supervisory relationship.

d. Demonstrate the ability to analyze and evaluate skills and
performance of supervisees including the ability to confront and
correct unsuitable actions and interventions on the part of the
supervisees. Provide timely substantive and formative feedback
to supervisees, along with providing cumulative feedback and to
train supervisees in techniques and methods in self-appraisal.

e. Present strong problem-solving and dilemma resolution skills
and practice skills with supervisees.

f. Develop and demonstrate the ability to implement risk
management strategies.

g. Practice and model self-assessment. Seek consultation as needed.

h. Conceptualize cultural differences in therapy and in supervision.
Incorporate and model this understanding into the supervisory

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 11

process.

i. Possess an understanding of group supervision techniques and
the role of group supervision in the supervision process.

j. Comply with applicable federal, state, and local law. Take
responsibility for supervisees’ actions, which include an
understanding of recordkeeping and financial management rules
and practice.

IV. Clinical Practice Standards
A. Post-degree/Pre-licensure
Clinical mental health counselors have a minimum of 3,000
hours of supervised clinical practice post-degree over a period
of at least two years. In the process of acquiring the first 3,000
hours of client direct and indirect contact in postgraduate
clinical experience, AMHCA recommends a ratio of one hour
of supervision for every 20 hours of on-site work hours with a
combination of individual, triadic and group supervision.

B. Peer Review and Supervision
Clinical mental health counselors maintain a program of
peer review, supervision and consultation even after they are
independently licensed. It is expected that clinical mental health
counselors seek additional supervision or consultation to respond
to the needs of individual clients, as difficulties beyond their range
of expertise arise. While need is to be determined individually,
independently licensed clinical mental health counselors must
ensure an optimal level of consultation and supervision to meet
client needs.

C. Continuing Education
Clinical mental health counselors at the post- degree and
independently licensed level must comply with state regulations,
certification and credentialing requirements to obtain and maintain
continuing educational requirements related to the practice of
clinical mental health counseling. Clinical mental health counselors

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 12

maintain a repertoire of specialized counseling skills and
participate in continuing education to enhance their knowledge of
the practice of clinical mental health counseling.

In accordance with state law, AMHCA recommends that in
order to acquire, maintain and enhance skills, counselors actively
participate in a formal professional development and continuing
education program. This formal professional development
ordinarily addresses peer review and consultation, continuum
of care, best practices and evidence-based research; advocacy;
counselor self-care and impairment, and AMHCA Code of
Ethics. Clinical mental health counselors who are involved in
independent clinical practice also receive ongoing training relating
to independent practice management, accessibility, accurate
representation, office procedures, service environment, and
reimbursement for services.

D. Legal and Ethical Issues
Clinical mental health counselors who deliver clinical services
comply with state statutes and regulations governing the practice
of clinical mental health counseling. Clinical mental health
counselors adhere to all state laws governing the practice of
clinical mental health counseling. In addition, they adhere to all
administrative rules, ethical standards, and other requirements of
state clinical mental health counseling or other regulatory boards.
Counselors obtain competent legal advice concerning compliance
with all relevant statutes and regulations. Where state laws lack
governing the practice of counseling, counselors strictly adhere
to the national standards of care and ethics codes for the clinical
practice of mental health counseling and obtain competent legal
advice concerning compliance with these standards.

Clinical mental health counselors who deliver clinical services
comply with the codes of ethics specific to the practice of clinical
mental health counseling. The AMHCA Code of Ethics outline
behavior which must be adhered to regarding commitment to
clients; counselor-client relationship; counselor responsibility
and integrity; assessment and diagnosis; recordkeeping, fee
arrangements and bartering; consultant and advocate roles;

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 13

commitment to other professionals; commitment to students,
supervisees and employee relationships.

Clinical mental health counselors are first responsible to
society, second to consumers, third to the profession, and last to
themselves. Clinical mental health counselors identify themselves
as members of the counseling profession. They adhere to the
codes of ethics mandated by state boards regulating counseling
and by the clinical organizations in which they hold membership
and certification. They also adhere to ethical standards endorsed
by state boards regulating counseling, and cooperate fully with the
adjudication procedures of ethics committees, peer review teams,
and state boards. All clinical mental health counselors willingly
participate in a formal review of their clinical work, as needed.
They provide clients appropriate information on filing complaints
alleging unethical behavior and respond in a timely manner to a
client request to review records.

Of particular concern to AMHCA is that clinical mental health
counselors who deliver clinical services respond in a professional
manner to all who seek their services. Clinical mental health
counselors provide services to each client requesting services
regardless of lifestyle, origin, race, color, age, handicap, sex, religion,
or sexual orientation. They are knowledgeable and sensitive to
cultural diversity and the multicultural issues of clients. Counselors
have a duty to acquire the knowledge, skills, and resources to assist
diverse clients. If, after seeking increased knowledge and supervision,
counselors are still unable to meet the needs of a particular client,
they do what is necessary to put the client in contact with an
appropriate mental health resource.

V. Recommended AMHCA Training
AMHCA recommends that clinical mental health counselors have
specialized training in addition to the generally agreed upon courses
and curricula endorsed by CACREP. These include the biological
bases of behavior, clinical assessment, trauma, and co- occurring
disorders technology assisted counseling, and integrated behavioral
health care counseling, working with children and adolescents,
and working with older persons. Knowledge and skills related to

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 14

the biological bases of behavior may be covered in a single course
or more commonly across several courses or domains of inquiry.
The skills outlined in this document can be measured through
standardized testing, participation in class or team role- playing
exercises, case studies, research papers, reviews of treatment
plans, and reviews of progress notes in field work settings. It is
recommended that the following be addressed for students in mental
health counseling programs of study.

A. Biological Bases of Behavior
The origins of human thought, feeling, and behavior, from the
more to the less adaptive, are the result of complex interactions
between biological, psychological, and …