Summary FOUNDATIONS_OF_MENTAL_HEALTH_COUNSELING.

FOUNDATIONS_OF_MENTAL_HEALTH_COUNSELING.I n an organized sense, mental health counseling is a young discipline. At the time of this writing, the profession is not quite age 35, but it remains a dynamic discipline, where there is still active debate about professional identity, role, function, and professional preparation. When the history of mental health counseling is written in a more definitive fashion than is possible in 2010, the past and present generation of activists and true believers may discover that their professional careers have paralleled most of the profession’s significant milestones and that they have had a hand in shaping their own destinies and that of their profession. Practitioners in few other fields have been able to make this claim. These first 30+ years have been dominated by establishing an identity, credentials, and recognition for the profession. Although these three dominant tasks are not yet complete, it is impossible to know what will evolve in the next 35 years. Thus, the history of mental health counseling is still very much in the process of becoming. Although the profession is rather young, mental health counseling did not emerge full blown in 1976 with no previous history. A number of antecedents led to the founding of the American Mental Health Counselors Association (AMHCA) in that year, and certainly there were many individuals who were practicing mental health counselors (MHCs) before they began to apply the title to themselves and their work. These antecedents do not form a traceable and purposeful historical path, but each may be considered an essential thread, without which the fabric of the profession would be less than whole. 5 6 Foundations of Mental Health Counseling HISTORICAL ANTECEDENTS The beginnings of contemporary approaches to the treatment of mental and emotional disorders are usually traced to the late 18th century. Prior to that time, persons suffering from mental and emotional disorders were either confined in asylums with wretched conditions and no systematic treatment or lived as itinerant paupers, driven from town to town. Earlier still, mental illness had been viewed as a spiritual disorder resulting from demonic possession and curable only by exorcism or burning at the stake. Moral Treatment The event usually credited with bringing about a change in attitude toward mental illness was the appointment in 1793 of Philippe Pinel as director of the Bicetre, the largest mental hospital in Paris. The French Revolution was in full flower, and Pinel brought the principles of “liberty, equality, and fraternity” to his new task. One of his first acts was to release the inmates from their chains. To the surprise of his critics, Pinel’s reforms worked. He forbade corporal punishment and used physical restraint only when his patients presented a danger to themselves or others. He introduced his methods to the Salpetriere, a hospital for women, when he was made director there in 1795. Pinel later wrote an influential book on institutionalized treatment, in which he developed a system for classifying various disorders and advocated the use of occupational therapy as an adjunct to treatment. He kept detailed statistics on the patient populations in his charge, and his claims of cure rates resulting from his methods are impressive even by contemporary standards (Murray, 1983). At about the same time, William Tuke, a Quaker, founded the York Re - treat in England. Although this was in many respects a utopian community, the Retreat focused on providing a restful, orderly environment in which those suffering from emotional disorders could return to normal functioning. During the first half of the 19th century in the United States, a number of reformers, most notably Dorothea Dix, were successful in founding private asylums and state hospitals operated on humane principles similar to those advanced by Pinel and Tuke. These highly structured environments emphasized the removal of distressed persons from their families or other accustomed settings, manual labor, regular religious devotions, and systematic educational programs aimed at redirecting thought patterns and teaching self-control. This combination of what would be known today as milieu therapy and psychoeducational programming represented a significant alternative to both the medical and custodial models of treatment. Crucial to the success of these institutions was the role of the attendants as models of appro-