What Makes a Good Mental Health Counselor?

There is strong demand for mental health counselors for the foreseeable future. The U.S. Bureau of Labor Statistics (BLS) estimates a 22% growth in counseling roles from 2021 to 2031. This projection means hospitals, mental health agencies and private practices will need at least 77,500 additional counselors over the next decade.

Skilled counselors are positioned to respond to the growing demand for mental health services. Newcomers to the field can develop good counseling skills and professional dispositions through their studies of the theories and practices that orient the profession. A good starting point in understanding the qualities of a good counselor is finding out what they do every day.

What Do Mental Health Counselors Do?

The National Institutes of Health (NIH) estimates that 52.9 million Americans experienced mental illness in 2020. Less than half (46.2%) of this group sought mental health services in the same year. Mental health counselors have treated those seeking better lives but many more are needed to reach all of those who need help.

Individual and group counseling explores the sources of mental health issues prior to the development of treatment plans. Counselors may use one or more of the following therapeutic approaches when assisting clients of all ages:

• Revealing meanings and motivations behind behaviors
• Addressing dysfunctional thinking at the core of behavior
• Assisting clients to make better choices and to understand themselves in relationship with others

Clients interact with mental health counselors across a variety of clinical environments. The BLS identified the following work environments for counselors in the United States in 2021:

• Outpatient mental health centers (19%)
• Individual and family services facilities (15%)
• Hospitals (10%)
• Residential mental health centers (9%)
• Government agencies (8%)

There are common experiences for mental health counselors no matter their work environment. Counselors maintain client documentation, consult with colleagues in support of their clients and adapt treatment plans based on ongoing evaluations. Good counseling skills and professional dispositions are essential to achieving the greatest impact from patient interactions.

Qualities of a Good Counselor

Aspiring mental health counselors may wonder what skills are necessary for success in the profession. After all, it is difficult to improve patient outcomes without establishing goals for counseling practice. Dr. Bradley Erford - a former president of the American Counseling Association - describes good counseling skills and professional dispositions including:

“...instilling hope, quickly centering on achievable objectives, judiciously selecting evidence-based practices, maximizing out-of-session change opportunities, and facilitating treatment adherence and follow-up…”

Erford argues that advocacy, empathy and flexibility are the most useful skills for mental health counselors. These attributes build trusting relationships with patients no matter their condition, background or reason for seeking treatment. The Occupational Information Network lists additional skills needed for counseling success:

• Social Perceptiveness
• Active Listening
• Service Orientation
• Judgment and Decision Making

Health inequities and disparities have led to growing rates of depression among underserved communities. Counselors who are sensitive to human experiences within diverse cultures recognize each client’s unique situation. An important quality of a good counselor is treating patients where they are rather than in an ideal context.

Standards for Effective Counseling

The question “What makes a good counselor?” can also be answered by the standards set by professional organizations. These standards are used by counselors and employers when applicable to ensure best practices for client care. Frequent review of professional standards also orients counselors as client needs evolve over time.

The Association for Assessment in Counseling and Education (AACE) published 12 standards for client assessment and evaluation. Mental health counselors use this list to shape their professional development. The skills of a good counselor based on these standards include:

• Identifying strengths and weaknesses in assessment techniques
• Communicating assessment results in clear and respectful ways
• Adapting treatment programs based on efficacy and client needs
• Promoting assessment skill building when in leadership roles

Core standards from the American Mental Health Counselors Association (AMHCA) recognize the dynamic skills required for effective counseling. Graduate and continuing education throughout a counselor career should reinforce standards including:

• Integrated Behavioral Health Care Counseling
• Substance Use Disorders and Co-occurring Disorders
• Technology Supported Counseling and Communications
• Trauma-Informed Care
   

Legal and Ethical Requirements for Counselors

Mental health counselors succeed when they build positive relationships with their clients. Trust can only be built when counselors follow legal and ethical standards for the profession. State laws and professional codes protect clients of all ages from harm while reducing potential conflicts of interest for counselors.

The National Board for Certified Counselors (NBCC) lists 95 directives in its Code of Ethics. Clients, employers and fellow counselors rely on these directives when identifying ethical issues. The Code of Ethics is summarized by NBCC statements including:

1. National Certified Counselors (NCCs) take appropriate action to prevent harm.
2. NCCs provide only those services for which they have education and experience.
3. NCCs promote the welfare of the recipients of provided professional services.
4. NCCs communicate truthfully.
5. NCCs recognize the importance of and encourage active participation.
6. NCCs are accountable for their actions and adhere to recognized professional standards.

The American Counseling Association (ACA) defines professional guidelines for counselors in its Code of Ethics. This document establishes the following core values for ethical decision-making by mental health counselors:

1. Enhancing human development throughout the lifespan
2. Honoring diversity and embracing a multicultural approach
3. Promoting social justice
4. Safeguarding the integrity of the counselor-client relationship
5. Practicing in a competent and ethical manner

Selflessness is required for counselors who want to serve their communities. The AMHCA reinforces this concept in its 2021 Standards for Practice by noting, “Clinical mental health counselors are first responsible to society, second to consumers, third to the profession, and last to themselves.” Good counseling characteristics are built by centering attention on others in clinical settings.

State Licensing Requirements

State licensing boards enforce legal and ethical requirements for mental health counselors. Each state establishes its own standards for licensure based on supervised practice, education and exam completion. 

The highest level of mental health counseling licensure varies from state to state.The American Counseling Association (ACA) identified the following distribution of licensure types across the United States:

• Licensed Professional Counselor (LPC) in 24 states
• Licensed Mental Health Counselor (LMHC) in 7 states
• Licensed Clinical Professional Counselor (LCPC) in 7 states
• Licensed Professional Clinical Counselor (LPCC) in 6 states
• Licensed Clinical Mental Health Counselor (LCMHC) in 4 states
• Licensed Professional Counselor of Mental Health (LPCMH) in Delaware
• Professionally Licensed Mental Health Practitioner (PLMHP) in Nebraska

We’ll use Ohio’s LPC initial licensure process as an example for new mental health counselors. LPCC applicants demonstrate their adherence to legal and ethical requirements by completing the following steps:

• 24 months and 3,000 hours of supervised experience following graduate school
• An LPCC online application including payment of a $100 application fee
• Results from the National Clinical Mental Health Counseling Examination (NCMHCE)
• BCI & FBI background checks

Exams Required for Licensure

Mental health counselors need to pass exams from the National Board of Certified Counselors between graduate school and licensure. The NBCC tests counselor competency prior to unsupervised practice with the National Counselor Examination (NCE) and the NCMHCE. Each exam includes components related to professional standards including ethical counseling.

The NCE tests domains including assessment, treatment planning and core counseling attributes across 160 scored items. This exam used by licensing boards in all 50 states includes 19 scored items related to professional practice and ethics. Test takers show their knowledge of legal and ethical requirements by answering questions about:

• Confidentiality in electronic communication
• Establishing group rules, expectations and termination
• Informed consent
• Identifying the need for consultation and supervision

The NCMHCE takes a different approach to evaluate counselor preparedness for practice. Ten case studies simulate the participant’s knowledge of assessment, diagnosis and treatment processes. Mental health counselors become comfortable with the characteristics tested in the NCE and NCMHCE at Walsh University.

Learn Effective Counseling at Walsh University

Walsh University offers an Online Master’s in Counseling and Human Development without graduate exam or residency requirements. Students choose from Clinical Mental Health Counseling, School Counseling and dual-degree options based on their career goals. There is one-on-one support available to each student from admission through graduation.

Clinical Mental Health Counseling

The Clinical Mental Health Counseling specialization trains future counselors through 100% online coursework, two internships and a practicum. A dedicated field experience team helps identify approved sites to complete field work requirements within each student’s community. Good counseling characteristics are reinforced through courses including:

• Assessment in Counseling
• Foundations for Practice
• Ethics/Issues in Counseling
• Social/Cultural Diversity in Counseling

Good Results for Students

Students realize strong returns on their investments in Walsh University education. Clinical Mental Health Counseling candidates achieved a 100% pass rate on the NCE in 2021. The university’s recognition as a 2022-2023 College of Distinction relied in part on strong student outcomes.

Learn how Walsh University’s Online Master’s in Counseling and Human Development can help you inspire change in your community.