How the Counseling Field Confused Branding with Substance, and Set Itself Up to Lose

Part 1 of 5 in the series Connecting the Dots: The Price of Fragmentation in Mental Healthcare

We Built a Professional Identity and Called It a Profession

I went back to school for my PhD in Counselor Education and Supervision because I genuinely believed in what I was walking into. CES has 5 pillars: counseling, supervision, teaching, leadership, and research. By that point I had years of clinical experience, I had supervised clinicians, I had watched the field evolve, and I wanted to be part of shaping the next generation of therapists. The CES program’s leadership pillar is what truly drew me in. I thought I was going to learn how to be a leader in the field, receive mentorship to develop my leadership skills in the areas the field desperately needs, and find support in critical analysis of where we are falling short in developing leaders in behavioral health organizations. What I found instead was a professional identity indoctrination machine and I want to be honest about how disappointing that was.

What the program wanted from me, more than anything, was to take on a prescribed professional identity. To become a Counselor with a capital C in the specific way the field had decided that meant. The more time I spent inside it, the more I realized that identity was built on claims I didn’t believe were accurate, distinctions I couldn’t defend intellectually, and a wall of political investment in separating counseling from everything adjacent to it. I left after two years. It was the right call. But I’ve been thinking about what that machine produces ever since.

The CES leadership curriculum I experienced was a perfect microcosm of this failure. The doctoral program that was supposed to train future leaders of the profession had us taking courses in “leadership” that amounted to little more than quoting ACA leadership frameworks with assignments geared toward serving specific clinical populations. It felt like masters-level administrative work dressed up as doctoral leadership. When I pushed back on that, the program got uncomfortable. When I was struggling and went to the faculty member I trusted most to talk about how to effectively engage in this program, she literally told me to just “check the boxes” to get through it. When I went to her about whether to stay in the program due to my feelings of misalignment and sense that the program felt incongruent and I questioned how the professional identity was being assigned to us, she asked me if I had spoken with the program director about unenrolling. That was it. The person I had hoped would be a mentor routed me to an administrator. The institution’s reflex was procedural, not relational, and this in a program training future counselor educators.

Where This Profession Actually Came From

Before you can understand what the counseling identity project got wrong, you need to understand what it was built on. The counseling profession did not begin as a clinical enterprise. It began with Frank Parsons, the father of vocational guidance, who coined the term “counselor” in the pre-World War II era to distinguish his vocational guidance work from legal practice. The profession initially focused entirely on vocational and school guidance counseling as reflected in the original organizational title: the National Vocational Guidance Association in 1913. This morphed into the American Personnel and Guidance Association (APGA). When APGA, the organization that eventually became the American Counseling Association (ACA), was founded in 1952, it was primarily concerned with vocational guidance and personnel activities. Counseling wasn’t even in the title.

This origin matters clinically and organizationally. The wellness and developmental orientation that CACREP programs teach as core counseling philosophy makes complete historical sense for career counseling and school guidance settings. The problem is that clinical mental health practice grafted onto that root system without ever honestly reckoning with the fact that it was a fundamentally different enterprise. A career counselor helping a client identify their strengths and navigate a career transition is doing something meaningfully different from a clinical mental health counselor working with someone in the grips of complex trauma, serious mental illness, or chronic suicidality. The wellness framework is appropriate for the first context. Applied uncritically to the second, it becomes a liability.

The American Mental Health Counselors Association (AMHCA) actually began as a division of ACA in 1978, a recognition that clinical mental health practice needed its own organizational home. It became a separate not-for-profit organization in 1998 and completed a full disaffiliation from ACA in 2019, with the stated rationale that clinical mental health counseling had grown into something distinct enough from ACA’s broader umbrella to warrant full independence. That is a reasonable position. But AMHCA currently has approximately 7,000 members representing perhaps 5% of the workforce it claims to speak for while ACA has over 45,000. The separation was philosophically correct and organizationally underresourced. More on that in a moment.

There Are No Theories of Counseling

Something hit me in a profound way when I looked at a textbook that was being used in a CMHC program. It was called “Theories of Counseling”. Let me say the thing that needs to be said: there are no distinct counseling theories. Not one. Every theoretical framework the counseling field claims as its own: CBT, psychodynamic approaches, attachment theory, object relations, systems theory, ACT, DBT, existential therapy, all originated in psychology, psychiatry, or adjacent fields. The counseling profession did not produce these ideas. It inherited them, created textbooks called “Theories of Counseling”, and then spent considerable institutional energy arguing that it was nevertheless a distinct discipline.

The developmental focus that counseling programs claim as a professional identity marker? Developmental theory comes from psychology. Erikson, Piaget, Kohlberg, all of which are psychologists. The lifespan frameworks that CACREP programs teach as part of counselor identity were not invented by counselors. And the “wellness orientation” that is supposed to differentiate counseling from clinical psychology collapses the moment you look at where LPCs and LMHCs actually work: community mental health centers serving people with serious mental illness, complex trauma, poverty, and housing instability. That is not a wellness population. Even in private practice settings, the populations we work with fall outside of this "wellness" paradigm they are selling. It also negates the fact that in order to bill insurance we must diagnose. The philosophy disconnected from clinical reality a long time ago.

The field has also been borrowing liberally from social work for years. Advocacy frameworks, social justice language, systems-in-environment thinking, and often without meaningful credit to the discipline that developed those ideas. In my CES program we were pushed to focus exclusively on counseling literature, which I found to be an arrogant and limiting approach to advancing the field and the ideas we were asked to research and embody. Everyone is borrowing from everyone else while simultaneously insisting they are distinct and special. The intellectual honesty of that position is essentially zero.

CACREP and the Accreditation Consolidation

I trained at The Chicago School of Professional Psychology, in a program offering an MA in Clinical Psychology with a Counseling Specialization. My professors were clinical psychologists. At the time I didn’t fully understand why that degree would eventually become a credential that didn’t fit cleanly into the licensure landscape. I understand it now.

The Council for Accreditation of Counseling and Related Educational Programs (CACREP), was established in 1981 by ACA’s governing council resolution, then structured as a legally independent organization. It has spent the last two decades consolidating its grip on the counseling profession. Programs like the one I attended, which existed productively in the space between psychology and counseling, have faced mounting pressure to rebrand as Clinical Mental Health Counseling (CMHC) programs, restructure their curricula to fit CACREP’s framework, and hire faculty who are themselves graduates of counselor education programs. That last requirement is the tell: CACREP mandates that core faculty come from counseling backgrounds, which means a program staffed by clinical psychologists, no matter how rigorous or clinically excellent, is structurally ineligible.

What is the clinical rationale for that requirement? There isn’t one. It is guild protectionism dressed up as quality assurance. And it is working: as of 2025, a growing number of states are legislating CACREP accreditation as a requirement for licensure. Florida joined Kentucky, North Carolina, and Ohio this year. The counseling profession is using the force of law to eliminate programs that don’t conform to its framework. Not because those programs produce inferior clinicians, but because controlling the pipeline is how a guild maintains power. And while we are speaking of “controlling the pipeline”, the creation of CACREP by the ACA means that the ACA is the only professional association that is discussed in these CMHC programs and membership in the ACA is often made to feel mandatory. Remember the discrepancy in membership numbers between the ACA and AMHCA? Yeah. It seems that the association that could benefit from our increased membership to push forward a real agenda that benefits mental health counselors has been pushed aside and made invisible by those overseeing these CMHC programs. 

There is an alternative accreditation body worth knowing about: the Masters in Psychology and Counseling Accreditation Council (MPCAC), which formed in 2011 specifically to accredit programs where faculty come from psychology and adjacent fields. MPCAC exists because a group of faculty recognized that excellent, long-standing programs were being made ineligible for CACREP accreditation not because of curriculum quality but because of who was teaching. MPCAC is philosophically correct. It is also politically outgunned, with no state currently mandating its accreditation for licensure while CACREP adds states to its required list. Being right and having institutional power are different things, and the counseling profession has understood that for a long time.

The Organizational Fragmentation Problem

Here is what the counseling profession’s governance structure actually looks like: four separate organizations, all with roots in the same parent body, all claiming to represent overlapping segments of the same workforce, none of them accountable to the others.

ACA manages professional identity and membership. CACREP accredits training programs. The National Board for Certified Counselors (NBCC) certifies individual practitioners. State licensing boards issue licenses. Each has its own governance, its own revenue model, and its own institutional self-interest to protect. And there is no unified ethical code. States have their own codes, NBCC has a code, ACA has a code, various ACA divisions have their own codes, and the AMHCA has their own ethical codes. A clinician navigating an ethical complaint could theoretically be subject to different standards depending on which body is examining the situation.

ACA created both CACREP and NBCC and then spun them off as independent organizations. That structure looks like a mature profession distributing governance functions. What it actually created was an ecosystem in which each organization can point to the others as responsible for the profession’s problems while protecting its own institutional territory. CACREP controls the training pipeline and feeds students into ACA membership. NBCC’s national certification exam is built on CACREP accreditation standards. ACA endorses CACREP as the accrediting body. The loop is closed, and AMHCA, the organization that most directly represents practicing clinical mental health counselors, sits outside it with 7,000 members and a fraction of the resources needed for effective advocacy.

Compare this to medicine: the AMA, ACGME residency accreditation, and the USMLE licensing exam represent a much more coherent professional pipeline, with physician specialty societies that maintain continuous organized presence in federal payment policy. The counseling profession has four organizations that cannot agree on a unified ethical code, let alone mount a sustained unified campaign on any issues that systemically and specifically affect those of us working within the mental healthcare systems.

This becomes most evident when looking at how physician residents are treated differently than associate level counselors. Both are under supervision and can't yet practice independently. Yet, the unified oversight of physicians has embedded this part of physician training into insurance models. There is no insurance company that won't pay for a resident, yet they often refuse to credential with a associate licensed mental health clinician. This is but one example of how our divisions have impacted our ability to do our work effectively and sustainably.

What the Identity Politics Actually Built

What the counseling identity project built, ultimately, was an elaborate structure for protecting professional borders rather than a coherent intellectual or clinical framework. It negated the realities of what our work looks like on the ground and the effects of misplaced advocacy that put us in a position to be constantly fighting with insurers over our training structure that contributes to the administrative and financial burdens we face everyday.

If the counseling profession had spent its energy developing a genuine theoretical contribution, building unified advocacy infrastructure, or creating training standards grounded in clinical outcomes rather than accreditation politics, it would look very different today. Instead we have a field that can tell you exactly how it is distinct from psychology and social work, but struggles to not only back up its claims, but also to answer the question of what that distinctness has actually produced for the clinicians doing the work or the clients they serve.

That accounting comes in Part Two.