Introduction

The professional identity of counseling is under construction. Who are we? How are we organized and governed? How is a counselor distinct from other mental health practitioners? Not only do potential counseling clients often struggle to answer such questions but frequently practitioners struggle as well. Contributing to our struggle is the fact that an exact definition of counseling is not readily available. Instead, its identity is developed through years of dialogue and collaboration among practitioners and counselor educators, clients and the broader public, colleagues within and beyond health services, and those who govern professions (e.g., law makers, regulatory agencies and accrediting bodies). This developmental process is the basis of professionalization.

This article endeavors to understand the professionalization process more fully, not only in the United States but in countries at various stages of professional development. An international panel discussion held at the 2016 American Counseling Association (ACA) conference and at the Canadian Counseling and Psychotherapy Association (CCPA) conference inspired further exploration of the development of the counseling profession. It was highlighted from the panel discussion of attendees that the counseling profession was at varying developmental stages in Botswana, China, Canada and the United States (Montgomery et al. 2016). It was indicated that Botswana was defining counseling as a profession but had not yet established an educational path or licensure for those interested in entering the field, whereas China had some education and licensure systems in place but was currently working toward standardization. Canada, like the United States, had established standardized professional systems of education and licensure.

Counseling is a relatively new profession, as compared to more established mental health professions such as psychiatry, nursing, and social work. The process to establish and legitimize a new profession is called professionalization or standardization. Bergman’s (2013) description of professionalization was adopted for this article: “The development of a health profession is an organic process that evolves over time. Individuals with common interests and orientations join together to implement shared goals, becoming more organized and legitimate” (p. 61). This professionalization process is occurring globally in the counseling profession right now, with different countries at different stages of the process. The professionalization of counseling involves development of internal systems such as licensure, accreditation, payment methods, training, marketing, and legal issues (cf., Bergman 2013; Bobby 2013; Hansen 2007; Kaplan et al. 2014; Lau and Ng 2014; Stanard 2013; Totton 2006); as well as the public’s perception and understanding of counseling (cf., Hanna 2011; Jorm 2012; Li 2012; Livingston et al. 2013; Myers and Sweeney 2004; Sharpley et al. 2004). There is considerable information in the literature about the steps being taken to achieve standardization of the profession, while there is equally considerable discussion of the risks and benefits of standardizing the profession. Professionalization is generally seen as important for the health and longevity of the field, while standardization raises concerns about losing the freedom and flexibility counselors count on in developing interventions and services that meets the needs of clients.

This article includes background on the professionalization process, an explanation of the questions asked of our global contributors, their responses, and an analysis of those responses. The result is a deeper understanding of the complexities involved in the professionalization of any field and especially one as dedicated to recognizing diversity as counseling seems to be. Ultimately, a list of steps necessary for the professionalization of counseling, based on the data analysis, is presented. The hope is that the steps will inform future professionalization efforts.

Background

Professionalization in the US

The impetus of the professionalization movement in the United States (US) is described by Kaplan and Gladding (2011) in their discussion of the American Counseling Association’s (ACA) ‘20/20: A Vision for the Future of Counseling’ initiative. They consider that three significant events have driven the professionalization of counseling within the US: (1) a presentation given by Walz, Gazda, and Shertzer in 1988 at the Association for Counselor Education and Supervision’s (ACES) conference on the future of counseling; (2) the inception of an international honor society for counseling students, counselor educators, and professional counselors (Chi Sigma Iota) in 1985; and (3) the ACA’s 20/20 initiative (Kaplan and Gladding 2011). The ACA’s 20/20: A Vision for the Future of Counseling effort brought together representatives from 30 stakeholders to outline steps that needed to be taken for the field to increase public understanding and professional integrity of the counseling field in the United States. The growth areas defined by the 20/20 governing delegation mirror the concerns and issues shared by the contributors to this article: (a) strengthening identity, (b) presenting ourselves as one profession, (c) improving public perception/recognition and advocating for professional issues, (d) creating licensure portability, (e) expanding and promoting the research base of professional counseling, (f) focusing on students and prospective students, and (g) promoting client welfare and advocacy (Kaplan and Gladding 2011).

Though the bulk of the literature on professionalization in the US is supportive of the effort, there are contradictory viewpoints. From the 20/20 delegation, ASCA disagreed with and thus declined to endorse a single counseling profession notion developed by the delegation (Kaplan and Gladding 2011). Beyond the 20/20 initiative, David Murphy (2011) argued that professionalization would lead to pathologizing clients and creating inauthentic counselors. Murphy’s argument was that standardizing the practice would invite controls that would be counter to the core values of counseling. He expressed concern that the shift toward greater standardization had already changed the training process “where once the primary focus was on the development of the person, the focus now [2011] appears to lean toward the development of competencies and skills” (p. 231). This argument, which he directed at counselor educators as having primary responsibility for designing and implementing training programs, can be summarized as the need to ensure that the essence of counseling involvement is not lost in the name of legitimizing it as a profession. This same concern was echoed in the responses of the contributing authors to this work and in related discussions.

It is necessary to understand not only philosophically what is involved in standardizing a profession but also the mechanics involved. Regarding the US, David Bergman (2013) offers a comprehensive discussion of the local, state, and federal government influences on the profession. One theme in his report was the significant amount of time and effort required to make changes toward professionalization. He pointed out that getting licensure for counselors in all 50 States took 33 years to achieve. He saw naming conventions as a further struggle, since States may have differing titles for the same profession. For example, in one State, a counselor who is practicing after passing their first licensure exam but who is not yet independently licensed is referred to as an LPC (licensed professional counselor), but is referred to as a PCC (professional clinical counselor) in another. Such differences represent challenges not only for those practicing in the profession but also for the public trying to understand the credentials of the professionals they engage. Bergman (2013), in his work, helped to outline why the professionalization movement is not just a discussion of core values, but also involves issues involving payers, license portability, and legitimization, which must be considered at a national level.

Accreditation

Accreditation is another factor that must be considered in the professionalization of counseling. The Council for Accreditation of Counseling & Related Educational Programs (CACREP) has played a significant role in the standardization of counseling in the US, as well as to some extent globally. Bobby (2013) argues that CACREP’s decisions have had a very specific impact on the profession’s identity and ability to standardize. For example, accrediting specialties as separate programs has contributed to the difficulties of presenting counseling as a unified profession. Her concerns about standardization were supported by Bergman’s (2013) report that an independent auditor working on behalf of the Federal Government recommended that CACREP-accredited degrees be a requirement for any counselor hired by the US Federal Government. Though the role of CACREP has been hotly debated within the profession, the CACREP organization was included as one of the participants in the ACA’s 20/20 delegation (Kaplan and Gladding 2011). The discussion of accreditation throughout the literature places it as a central influencer on the professionalization of the field.

Professionalization and the Global Arena

There is literature that specifically addresses the role of professionalization globally. Tang et al. (2012) discussed the need to professionalize counseling scholarship, teaching and practice not only within separate countries but also internationally. The globalization of counseling is an extension of the discussion of localized professionalization, especially since many countries compare the development of their best practices with those established in other countries (cf., Brian and Ben-Zeev 2014; Grabosky et al. 2012; Guo et al. 2013; Hutz-Midgett and Hutz 2012; Lee et al. 2012; Lim et al. 2010; Ng and Noonan 2012; Okech and Kimemia 2012; Okocha and Alika 2012; Panayiotopoulos et al. 2012; Portal et al. 2010; Richards et al. 2012; Schofield 2013; Simons et al. 2012; Thomas and Henning 2012). Livingston et al. (2013) explained that agencies and organizations in the US, governmental and non-governmental, were making resources available to address stigma and barriers to help-seeking for mental health issues. The bulk of the literature on professionalization coming from the United States has focused on the views and opinions of counselors, whereas, much of the literature from other countries has focused on empirical studies of public opinion (cf., Panayiotopoulos et al. 2012; Reavley and Jorm 2011; Sharpley et al. 2004). Research conducted by the World Health Organization’s (WHO) world mental health (WMH) survey initiative (Wang et al. 2007) covered various settings around the world. The project reported that the need for effective mental health care was a worldwide imperative, and suggested that lack of data was one in a set of contributing factors impeding the professionalization of mental health professions globally. The WMH survey explored public perceptions in an effort to close the gap in global data about engagement in mental health services.

The evolution of the counseling profession across different regions in the world reveals that social, historical, political, economic, and cultural contexts are vital factors in the development of counseling as a profession. In the US, vocational guidance, veterans’ legislation, the National Defense Education Act, and the civil rights movement shaped the emergence and professionalization of counseling in the 1950s and 1960s (Evans et al. 2013). In Africa, social and economic changes, such as independence and the HIV epidemic, created high demands for making helping professionals available (Okech and Kimemia 2013; Stockton et al. 2013). Enormous changes in the economy and urbanization in China also led to huge anxiety and stress among people and an increasing need for professional help (Lim and Lim 2013). Counseling as a profession in many countries started as guidance in schools and colleges and became more recognized as a profession in such communities (See and Ng 2010; Watanabe-Muraoka 1996). Hohenshil, Amundson and Niles (2013, p. 5) stated that “The need to expand the counseling profession is gaining considerable global support because of the increased industrialization that is resulting in changing family structures, new political alliances, and advances in communication technology”.

With the increasing need for counseling, there are questions about training, standardization, professionalization, and accreditation. The influences from the US to other countries have already been noticed by scholars (cf., Tuason et al. 2012) and been questioned for meaning and implications of counseling in relation to indigenous healing (Watanabe-Muraoka 2007). Establishing a professional identity, or whether professionalism of counseling would benefit clients or practitioners in the local community, has been debated (Totton 1999). On the other hand, in Canada, there is a pragmatic need (e.g., mobility and accessibility) to have common terminology and professional standardization where there are 140 professional associations related to counseling and over 40 job titles for counselors and related helping professionals (Neault et al. 2013).

This literature review regarding the professionalization of counseling provides some insight into the steps required to professionalize any new field and an understanding of the specific challenges faced by the field of counseling. However, more broadly, it also raises questions about the experience of counselors and leaders in the counseling profession from around the globe in terms of the professionalization of counseling. In fact, it suggests that the field internationally cannot really be referred to as “the counseling profession”, as in many countries there is no real standardization of terminology, practice and organization in line with what is known about what essentially is a profession. In the context of this issue, it seemed important to hear directly from leaders in other countries about what they were observing and experiencing regarding the counseling field.

Global Perspectives

To pursue this objective, a set of questions was created based on the literature reviewed above and from our personal experiences as practitioners, counselor educators, students and advocates for the counseling profession. Responses were solicited from industry leaders in Canada, Botswana and China (the countries previously noted as being locations where the counseling profession was seen as being at differing stages of development) based on their training, professional experience, leadership in professional organizations and publications. The contributors were: Dr. Blythe Shepard, former president of the Canadian Counselling and Psychotherapy Association and professor at the University of Lethbridge; Dr. Hildah Mokgolodi, professor at the University of Botswana as well as an active advocate for the development of the counseling profession in Botswana; and Professor Mingyi Qian, former president of the Chinese Psychotherapy and Counseling Association, professor at Peking University, president of the Chinese Registry of Mental Health Clinicians, an advocate for the standardization of the profession in China and someone who has published extensively on the professionalization of counseling psychology in China. The following are the questions asked and responses received from these global contributors. The complete responses are included here as the contributors took the time to be concise and specific.

  • Question 1: Do you think the professionalization of counseling is important in your country? Why?

    B.S. (Canada):

    Professionalization of the Profession is important. Professionalization of counseling has been a goal in many Canadian provinces for the past 15 years. Regulation of the profession occurs through our provincial regulatory process, typically under the Ministry of Health. Currently, Canadians are faced with a combination of regulated and unregulated environments for the profession, resulting in variations in expected competencies and qualifications of entry-to-practice candidates. Additionally, the mechanism by which regulation occurs may be different in various provinces. At this point in the history of the profession, there are three provinces that have regulatory colleges (Quebec, Ontario, and Nova Scotia), four provinces that have made substantial progress (New Brunswick, Prince Edward Island, British Columbia, and Alberta) and three that are mobilizing the various counseling and psychotherapy associations in their province (Manitoba, Newfoundland, and Saskatchewan).

    So with the exception of the province of Quebec (regulated since 1963), and most recently Ontario (2015) and Nova Scotia (2011), there are no statutory requirements to be[coming] a counsellor in Canada. Due to the lack of regulation, people practising in this field do so under many different titles such as counsellor, psychotherapist, counseling therapist, art therapist, clinical counsellor, guidance counsellor, marriage and family therapist, music therapist, drama therapist, pastoral counsellor, substance abuse counsellors, etc. (see Martin et al. 2013).

    The principal factor cited for statutory regulation is the risk of harm to the public, since the practice of counseling often takes place in private unsupervised settings with emotionally vulnerable clients. Since anyone can call themselves a counsellor, statutory regulation will identify who is qualified to practice to promote and ensure public protection, to increase accessibility of services and to certify accountability through a continuing professional development requirement. With regulation, the standards and guidelines established by the profession are legislated and overseen by a Regulatory College who is answerable to the government authority.

    H.M. (Botswana):

    Yes, it is important in our country. The history of Botswana with regard to counselling is indicative of the political will and understanding in the area (see Stockton et al. 2010). However, things seem to have changed over the past 10 years; who sees the importance depends. As a counsellor it is important because: a) it would give standards by which we measure the quality of counseling in Botswana in comparison to the rest of the world, b) it can give counselling the respect and effective use it deserves (Botswana has experienced a lot of trauma and grief from not only HIV and AIDS but from passion killings and divorces, to mention but a few), and c) most graduates are unemployed because they pursued courses that may not necessarily be needed in the job market. That alone leaves graduates stranded and wanting to do almost anything to make a living. Professionalizing counselling could work at both ends of completing [qualifications] and job hunting. In Botswana, only professionalized programs are supported by politicians and hence are upgraded as need be.

    M.Q. (China):

    It is very important. Based on Phillips et al.’s (2009) survey, overall prevalence of mental health disorders of China's adult population is 17.5 %. According to this rate, China has nearly 1.73 million adults suffering from mental illness, which is similar to the prevalence of mental illness in Western countries. However, there are low attendance rates for services: 1.58 million of the 1.73 million people have never received any professional treatment. There are even more people with non-clinical but some sort of psychological problem in China who need counseling. In a word, there is a great need for psychological counseling.

    With a substantial increase in public demand, the number of counsellors in China is growing very fast, but there are a lot of problems associated with this fast growth. For instance, many counselors do not have counseling or psychology education backgrounds, and some became counselors after only a hundred hours of training courses, and passing a low threshold national counselor examination. Their professional competence and quality of service are problematic. How to guide and promote healthy and sustainable development of the work in this area, and promote the specialization and professional structure of psychological counseling is becoming a very important issue.

  • Question 2: The terms “professionalization” and “standardization” of counseling are used interchangeably by some practitioners, while others clearly distinguish the two. What are your thoughts on this terminology? How would you describe what is happening in your country with regard to these terms?

    B.S. (Canada):

    Professionalization in Canada refers to credentialing, licensing, registration, or certification. Although in most provinces counseling is not regulated, many employers do look for certified counsellors as this will demonstrate that they are professionals that are ruled by a code of ethics, a standard of practice, a disciplinary procedure and that they will have to update their skills regularly to maintain their certification.

    In Canada, standardization refers to competency. Affecting the development of all provincial/territorial title protection and/or reserved activity legislation is a national agreement, the Agreement on Internal Trade (AIT), which is an intergovernmental trade agreement aimed at reducing and eliminating barriers to the free movement of persons, goods, services, and investment within Canada. Rather than requiring specific credentials, adherence to the AIT involves standards based on competencies; that is, professionals in the field of counseling must demonstrate the ability to perform a practice task with a specified level of proficiency (see Martin et al. 2013).

    Efforts have been made in Canada to define the competencies required to perform activities within the profession; to function as expected for employment; and the ability to perform under a variety of conditions, including the ability to cope with contingencies. Between 2008 and 2010, the Canadian Counselling and Psychotherapy Association (CCPA) spearheaded a national research task force funded by the Canadian government to ensure that appropriate tools and supporting materials for the counseling profession had a national consensus. Stewards of the profession were recruited from each Canadian province to contribute to a professional, open dialogue that culminated in the 2011 National Symposium on Inter-Provincial/Territorial Mobility within the counselling profession. A bilingual national survey of 46 organizations and 1,416 individuals who identified themselves as within the profession of counseling and psychotherapy revealed a pan-Canadian agreement on the definition of counseling and its scope of practice. Although respondents self-identified with more than 70 different specific counseling-related titles, there was consistently over 93% agreement, and less than 4% disagreement on all components related to the profession and its scope of practice, clearly indicating that there is indeed a single, cohesive profession with a single, cohesive scope of practice. (see Martin et al. 2013).

    In British Columbia, a set of entry-to-practice competencies was developed in 2006. These competencies were then validated across Canada and were made available for use by all provinces and territories. These competencies were revised by the College of Registered Psychotherapists in Ontario (CRPO). Recently these competencies were revised again and will be nationally validated in 2017.

    In terms of standardization of counsellor education programs, Master’s-level counseling programs can voluntarily submit to a self-study that is reviewed by the Council on Accreditation of Counsellor Education Programs (CACEP) under the auspices of the CCPA. In order to become accredited, a counsellor education program must fulfill certain requirements or standards with regard to institutional settings, program mission and objectives, program content, practicum experiences, student selection and advising, faculty qualifications and workload, program governance, instructional support, and self-evaluation (see Robertson and Borgen 2016).

    H.M. (Botswana):

    Standardization of programs is what makes them professional; therefore, professionalization results from standardizing certain things. For instance, to be accredited in a profession one has to satisfy certain demands of the profession. Professionalization means one can be held accountable for their actions and the profession can be guided in a certain way, while standardization is a measure of that guide.

    M.Q. (China):

    There should be a difference between professionalism and standardization. Professionalism means that counselors and psychologists should be listed as a profession in the national classification of occupations; this profession has its position in the field of mental health services, has its own standards of entrance to the profession, and has a specific service scope and requirements. People working in the counseling field should have a professional identity, their own career path, and be able to rely on the rewards of working in the field, making a living, and gaining a sense of accomplishment.

    Sandardization means psychological counseling as a career adheres to certain regulations; for example, counselling professionals need to follow the professional standards, professionals need to go through training, internships, and supervision by certain standards. There are certain standards for certifying qualified personnel.

  • Question 3: What is the status of the counseling profession in your country? How is it positioned in relation to other mental health professions? What challenges do you experience in establishing and maintaining a unique professional identity?

    B.S. (Canada):

    It is difficult to accurately estimate the number of counselors currently practicing in Canada. Based on projections from those provinces that produce data, a rough estimate is that there are approximately 40,000 persons across Canada providing counseling related to mental health and/or personal growth. The challenge in determining a firm number is partly due to the lack of common nomenclature across the profession. Many in the profession belong to professional associations such as the Canadian Counselling and Psychotherapy Association (CCPA; 5700 members).

    The profession is now at the table with other health professions. [The] CCPA has spent much time and effort over the past several years to increase the visibility of the profession by our contributions to health-related national associations including the Canadian Alliance on Mental Illness and Mental Health (CAMIMH) and through partnerships with the Mental Health Commission of Canada (MHCC), the Canadian Primary Health Care Research and Innovation Network (CPHCRN); the Health Action Lobby (HEAL); and the Psychotherapy Practice Research Network (PPRNet). CCPA has elevated the awareness of the profession of counseling and psychotherapy to other professionals, government ministries, research funders, and the public.

    Psychotherapists and counsellors have extensive education that includes at least a master’s-level training and they are highly trained mental health specialists focused on promoting mental health, wellness, and recovery. The role of psychotherapists and counsellors in the continuum of care is complementary to the work of family physicians, psychiatrists, and psychologists for patients with a serious mental disorder based on the DSM-5. Now as a profession we [counselors] strongly advocate for our position on the continuum of mental health care. However, we face a number of challenges in establishing and maintaining a unique professional identity. The diversity in professional identities and scopes of practice (and overlapping scopes of practice with medical doctors, nurses, social work, psychologists, etc.) pose serious challenges for Canadian regulators as well as for the public. More established professions such as psychologists and social workers are regulated, share scopes of practice with our profession, and are included in many health benefit plans. The public knows them and they have one name – it is clear.

    In the 2011 national [counselors] survey (CCPA 2011) participants identified more than 60 unique areas of practice. The most common were general mental health, marriage and family, addiction, career, school-based, and postsecondary counseling. From the list obtained it is clear that some Canadian counselors define their practice by client group (e.g., mental health, family, addiction, Aboriginals) and others define their practice by counseling approach or modality (e.g., career, play, creative arts, pastoral).

    Currently in Canada, the major issues that are holding back the regulation of counseling in any jurisdiction appear to be:

    1. (a)

      the need to prove a case for regulation by a thorough risks-of-harm analysis, and through that analysis, to define the most appropriate model for regulation;

    2. (b)

      the need to define what constitutes counseling for the purposes of regulation;

    3. (c)

      the need to define what the competencies should be for entry into the profession; and,

    4. (d)

      the need for the different counseling associations whose various members would be regulated by a single college to demonstrate cooperation and agreement on the major issues, including a commitment to fund the start-up phase of the college.

    H.M. (Botswana):

    There is a mental health professions body that registers people in these fields; however, the body has completely refused to recognize counselling as a mental health profession. Anything ending with psychology other than the medical areas will be considered by the professions body. The counselling profession in Botswana is struggling to make itself known and be known as a profession. The lack of a professional body governing who is and who isn't a counsellor is what makes counselling here look fluid. Interestingly, we are sought out when there are crisis situations to attend to. For instance, in November 2015, we lost in a car accident 8 students who were being delivered to their home villages. It was a traumatic situation that is still being dealt with as we speak. Nurses needed counseling, the driver needed counseling, the parents needed counseling, the teachers and students needed counseling and the counsellors were burnt out because there are not adequate human resources to address this. The professional association is used to try and establish and help maintain the professional identity of counsellors, which does not seem to be enough.

    M.Q. (China):

    In 2002 the Chinese Labour Department (later changed to Human Resources and Social Security Department) issued National Counselor Occupational Standards. In 2003, a counselor examination was introduced (see Ministry of Human Resources and Social Security, 2009). So far more than 90 million people [have] received the counselor certification by passing this qualification examination.

    Despite a large number of these counselors holding the certificate, only very few entered the field of psychological counseling, working as professional counselors. The reason is the low threshold to be certified as a counselor (initially [one] only needed high school, graduate level, and later changed to college [level]), short training time (a hundred hours of training and no internship requirements); thus these certification holders do not actually have the competency required for [being] a professional counselor. As a result, they are widely criticized. Such counselors mainly work in private consulting companies, and their professional identity is relatively low.

    In addition, some master's graduates from university training in clinical psychology or counseling psychology, now work in university student counseling centers. The counselors overall have high quality and competency. Most college counseling centers requests their counseling staff to participate in continuing education and provide professional supervision to the working staff. Only a few people from this group obtained the counselor certificate.

    Psychotherapy and counseling in China overlap and often do not discriminate between populations served; theories and techniques used in the work are similar. Some counselors working in the higher education institutions graduate from clinical psychology programs, and they maintain good relations with professional therapists working at a hospital. Many of the counselors in colleges and universities have better channels of communication with psychiatrists, and some even have good collaboration. In the face of the challenges, how to improve the quality of counseling professionals and standardize existing chaos in the consulting field is a serious problem.

  • Question 4: What strategies have you been involved with, directly or indirectly, that have strengthened counseling as a profession? What have you learned from those experiences that can help us continue to develop as a profession?

    B.S. (Canada):

    As the national association for the profession, CCPA has focused resources on strengthening counseling as a profession. The association received funding over three years to engage in a series of symposia aimed at strengthening professional identity, promoting mobility, and increasing cohesion with respect to the regulation of the profession by developing a national definition of counseling, a national scope of practice, and a list of research-based titles, etc. Since 2011, the CCPA began intensive work with the provincial regulatory colleges to enhance the flow of information and understanding across jurisdictions through the Pathways Project to facilitate the mobility of counselors across provinces. CCPA continues to take an active role in regulatory activities in each province.

    CCPA works closely with a media company that specializes in helping national organizations to deliver effective communications to the public, their members, key stakeholders, and government ministries. Over the past year, this area of activity has grown immensely, largely due to communication-related initiatives carried out, including: regular press releases on counseling-related issues with the federal government and Members of Parliament, and participation with national alliances/coalitions. For example, a CCPA issues paper, The Urgent Need for Counselling Services, was included in a grassroots advocacy toolkit mailed to all Members of Parliament and Senators. Regular press releases include raising awareness for Fetal Alcohol Awareness Disorder, acknowledging World Suicide Prevention Day, and drawing attention to violence against women, to name a few.

    The CCPA is engaged with the Mental Health Commission of Canada, Members of Parliament, and regulatory colleges to advocate on behalf of our members and the people they serve. CCPA representatives also met with four Members of Parliament who belong to the Standing Committee on Health (HESA) to seek guidance on how CCPA can provide input to the development of the health accord.

    The CCPA engaged in a letter writing campaign to advocate for the inclusion of counselors as eligible service providers to veterans and their families. This campaign resulted in meetings with 11 MPs in Ottawa. The meetings resulted in an invitation to meet with [the] Deputy Minister of Veterans Affairs. CCPA was then invited to prepare a written brief for consideration within the context of the Standing Committee on National Defence (NDDN) study (Parliament of Canada 2014), “Care of Ill and Injured Canadian Armed Forces Members.”

    Our learning helps us to develop as a profession as we actively advocate for the profession, hire professionals to assist in developing an action plan, encourage the membership to meet with their Members of the Legislative Assembly about the need for regulation of the profession, get involved in regulatory activities, reach out to international associations to share resources and work collaboratively to professionalize counseling/psychotherapy, and support research and publications based on Canadian research.

    H.M. (Botswana):

    I am a counsellor educator. That alone is demanding on my part to lobby for counselling as a profession, not only to students but to other faculty and policy makers. I also have referrals from the community. I have worked for the ministry of education for skills development in Botswana, training teachers on basic counselling skills, emotional intelligence and helping develop programs for schools from primary through tertiary to say the least. We had donor-funded projects that tried to reach out to people in the communities, but they failed because government was not prepared to take them over; for instance, programs called youth counselling on air, which allowed learners, teachers and parents from all over the country to call in when they had a counselling need and had no counsellor close by. That program I led for a while and it actually helped people appreciate counselling.

    Until the political-will appreciates counselling as a profession, ‘math’ will always come first. But I have to keep lobbying for it whenever opportunities present themselves.

    M.Q. (China):

    With these above-mentioned challenges, how to guide and promote healthy and sustainable development of the work in this area, and how to manage and regulate the development of the profession becomes the most important and critical task. As a result, the Registration Committee of Chinese Associations of Clinical Psychology (hereinafter: the registration system) was founded in 2014 in order to register professional helping agencies and professionals within the Clinical and Consulting Psychology Specialty of the Chinese Psychological Association.

    The registration system aims to have effective internal control and self-management for the psychological counselling and psychotherapy industry; striving for self-discipline and promoting the healthy development of the industry as a whole. After consulting the documents pertaining to regulation and management of the profession from the American Psychological Association (APA), American Counseling Association (ACA), American Social Worker Association (ASWA), American Family and Couple Therapists Association (AFCTA), British Psychological Association (BPA), Canadian Psychological Association (CPA), European Association for Psychotherapy (EAP), as well as the pertinent documents from Hong Kong and Taiwan, the registration system drafted two regulation documents. In 2007, these documents were approved by the Chinese Psychological Association’s Executive Council. Then the Chinese Association of Clinical Psychology and Counseling Psychology of professional agencies and professional registration standards and the Chinese Psychological Society Code of Ethics for Counseling and Clinical Practice (hereinafter Code of Ethics) (Chinese Psychological Society 2007) were officially published.

    The registration system has three Working Committees including: a registration standards group (responsible for modifying the standards), a registration management group (responsible for professional registration of the individual professionals and the professional agencies or units of registration), and an ethics group (responsible for ethics awareness education, receiving and processing ethics complaints, and so on). The registration system standards refer to quality control of professional work, and the registration system has strict rules on registration procedures and stringent gatekeeping.

    Currently [as at 2009], there are 811 registered assistant psychotherapists, psychotherapists, and supervisors, 70 registered continuing education programs, and 14 registered internship agencies (Teaching Office of the Department of Human Resources and Social Security 2009). In the future there will be registration for postgraduate training programs in clinical and counseling psychology. The effort now is actively seeking support from pertinent units of government.

    The code of ethics, created by the registration system and endorsed and published by the CPA, is actually the first code of ethics being implemented in China (Qian et al. 2009). By 2016, the ethics committee in the registering system has addressed a number of complaints, including one case in which the supervisor who had sexual relationship with a client was removed from registration. These kinds of work have earned the registered system a good reputation within the professional field at home and abroad.

    In our process of advancing the registration system, we feel that adhering to professional standards is critical to improve the quality of mental health services; acting in accordance with ethical guidelines is critical to safeguard the interests of clients and protect the reputation of the industry.

    In addition, due to the problems associated with the large number of nationally certified counselors, the first Mental Health Act (The National Peoples’ Congress 2012) introduced in 2012 and formally implemented in 2013 restricts the scope of services of Chinese psychology workers. Therefore, in order to promote the development of professional psychological counseling, one needs to press the administration to support work in this area, to establish separate laws of psychology, and to have legislative protection for the specialization and professionalization of psychological counseling.

  • Question 5: There is a trend toward standardization of both training and practice in the United States, particularly with the use of evidence-based practices and outcome measures. What is the current landscape of counselor training in your country? How does standardization of training for counselors affect the counseling profession?

    B.S. (Canada):

    In Canada, counselors are encouraged to use evidence-based practices and more counsellors are using outcome measures. As counseling becomes accepted as part of the continuum of care, the movement toward evidence-based and outcome-driven decision-making and resource allocation is an inevitability. In Canada, 60 unique areas of practice were identified. While the most common were general mental health, marriage and family, addiction, career, school-based, and postsecondary counseling, others included play, somatic, creative arts, sexuality, pastoral, trauma, and Aboriginal wisdom.

    Across Canada, most counseling psychology training programs are housed within faculties of education. The most common entry standard for being registered as a counselor (regulated or nonregulated) is a master’s degree in counseling or a related field. Currently there are about 50+ graduate-level programs in Canada. Course areas typically offered at the master’s-level are counseling theories, skills and interventions, consultation, assessment and testing, multicultural counseling (diversity), professional ethics, learning and human development, research and evaluation, career-life development, group counseling, and counseling in specialized settings. Supervised practice is a requirement of all programs recognized by Universities Canada.

    H.M. (Botswana):

    There is a long history in the training of counsellors in Botswana. Most of the trained counsellors at master's- and PhD-level were trained in the West. It follows that those trained in the West more or less determine what and how the counselling training should be like. From both my experience as a counsellor for the Ministry of Education within the curriculum development department and evaluation department, and [from] literature (cf., Mokgolodi 2011, 2015; Montsi et al. 2000; Stockton et al. 2010) the development of counselling in Botswana, and lack of legislature governing counselling and counsellors, impacts heavily on standardization and professionalization of counselling in the country. The master’s program, and to a large extent the bachelor’s programs, at the University of Botswana, which provides the highest number of professional counsellors, is based on the US structures. The program evaluators for both programs were also from US universities. Therefore, the issues of CACREP may indirectly affect us as our counselling is to a large extent guided by US standards.

    M.Q. (China):

    At present, there are calls for emphasis on evidence-based practice in the field of psychological counseling in China, but there is no strong force overall. Evidence-based psychological counselling or psychotherapy is beneficial to promote this field of work and counseling effectiveness. Having psychological measurement before and after the intervention, assessing the effectiveness of interventions, is helpful to improving and increasing effectiveness.

    In China, most training in the higher education institutions on clinical and counseling psychology are at the master’s-level; there are very few doctoral students. Doctoral students are required to have both research and clinical practice. For the master’s-level training, there is no uniform training system or framework. Most colleges and universities do not have the choice to offer the types of courses and internships, as well as the length of internships, they desire. Some teachers’ professional levels need to be improved, some courses are not offered, so it is difficult to have standardized training.

    The biggest problem for counselor training is that it cannot have its own independent discipline code for clinical or counseling psychology by the Chinese Psychology Association. The graduate training for clinical and counseling psychology is currently listed within applied psychology by the Chinese Psychology Association. This presents great challenges and barriers to clinical and counseling psychology graduate training in universities because the restrictions do not allow establishing independent, systematic curriculum, offering specialty courses, internships, as graduate students need to meet applied psychology requirements.

    To address these issues, the registration system considers the first step is to provide specialized training to existing teachers as soon as possible, to enhance their professional competency, and these teachers promote the systematic training courses in their own schools. Meanwhile, advocates for the state Department of Education set up a training guide for clinical or counseling psychology master’s programs, suggesting they follow the registration system of postgraduate education standards. If possible, the Government should authorize the registration system to certify universities and training programs in China to promote systematic and scientific training of clinical and counseling psychology students. The second step is to establish an independent academic discipline of Clinical Psychology and Counseling Psychology (level 2) under Psychology (level 1).

  • Question 6: Some have expressed concerns that standardizing the practice of counseling eliminates some of the effectiveness of counseling that comes from counselor creativity and autonomy. What are your thoughts on this perspective?

    B.S. (Canada):

    In Canada there are many pathways to becoming an effective counselor. For example, in Ontario, there are three pathways to regulation as a registered psychotherapist (College of Registered Psychotherapists of Ontario [CRPO] 2016). Successful applicants come from a structured, coherent program of education and training in psychotherapy which has as a prerequisite an undergraduate degree, and which includes 360 hours of training and education central to the practice of psychotherapy, excluding direct client contact hours and clinical supervision hours. Other applicants have a master’s degree, which includes at least 10 semester courses (360 hours) of training and education central to the practice of psychotherapy, excluding direct client contact hours and clinical supervision hours. Other applicants have graduated from a program that is deemed by the Registration Committee to be substantially equivalent to a program referred to previously that may be comprised of one or more programs (CRPO 2016).

    A pathways approach allows for practitioners to come from a variety of backgrounds. Sometimes their original professional education and training will have been in a field such as child and family services or pastoral counseling. Some will have completed an independent psychotherapy program offered at the master’s-level. Others will have completed a master’s program in a discipline related to the practice of psychotherapy. Still others may have completed a program (or possibly components of more than one program), assessed to be “substantially equivalent” to a master’s-level program.

    Most Canadian counselors accept the working alliance as foundational to any successful work with their clients. This may in part explain the apparent inconsistency in terms of theoretical influences or preferred modalities—counselors see many possible routes to achieve counseling success as long as an effective working alliance is in place (Neault et al. 2013, p. 308).

    The art of counseling trumps knowledge and intervention. The focus is not just on what counselors intend to communicate when responding to client content, but what is actually heard and taken away by clients. Therapy is a rather complex mix of relationship and wisdom, art and science, based on research, yet developing in its own unique way like a piece of art.

    H.M. (Botswana):

    Standards are good for guidance; however, I don't think they should restrict flexibility and creativity. In addition, the lack of standards for developing countries poses both ethical and legal issues. Without standardization, the people of Botswana cannot easily take anyone to task or make anyone accountable for unethical behavior as a professional. We are not recognized as a mental health profession.

    M.Q. (China):

    I am not in a position to answer this question due to the lack of standardization in China now.

  • Question 7: What do you see as the best way for us to work together as a global counseling community to strengthen the profession? What are some of the unique and exciting ideas you are seeing implemented either locally or globally to further strengthen and expand the counseling profession?

    B.S. (Canada):

    The best way for us to work together as a global counseling community to strengthen the profession is to share resources including research, knowledge, documents, and in-kind support. For example, Canada could share the entry-to-practice competency profile as a starting point. The field needs to offer multiple pathways to the profession to increase inclusivity. For example, the CRPO is exploring how to offer a pathway to regulation for Indigenous healers.

    Western countries need to recognize the important contributions to counseling from non-Western cultures, and to integrate practices from beyond their borders. There needs to be increased acknowledgement of the significance of spirituality in counseling practice.

    As the regulation of counselors across Canada continues to occur, there will be a growing need for applicants to obtain clinical supervision in order to meet the criteria for more direct face-to-face client contact hours than was required in their programs. Supervision training for those professionals with advanced skills and experience will be increasingly necessary. In 2013, the CCPA provided additional clarifications of standards for qualified supervisors, launched the CCC-S (Canadian Certified Counsellor–Supervisor) designation, and introduced a graduate course for supervisors.

    In 2011, the CCPA undertook a five-year research project to create the foundation for a Canadian national standard entry-to-practice assessment in both official languages that has the potential to be used by statutory colleges responsible for regulating the profession. The tool functions as one part of a multi-pronged approach of the licensure process based on the requirements of the province/territory. COMPASS Centre for Examination Development, a not-for-profit corporation, provides an online platform for a simulation-style, competency-based evaluation that aligns with the profession’s competency profiles.

    The CCPA hosts a public-facing website ( www.talkingcanhelp.ca ) to assist the public in understanding the role that counseling and psychotherapy can play in supporting individuals, families, groups, and organizations with concerns related to career, education, family, mental health, and mental illness (among others). The website provides the public with information about the profession, how to locate a counselor, what to expect from counseling, and many other awareness- and support-related facts.

    H.M. (Botswana):

    Technology has made the world a small place for all of us. Developing worlds learn a lot from exposure to best practices of the developed world, while developed worlds can learn a lot from indigenous settings of developing worlds. Multicultural aspects are encouraged but technology should not strive to make us one big country. For instance, the Counselling Association in Botswana is struggling to make its mark, but it can continue to learn from others. Sometimes I believe, the challenges existing in all spheres of any profession are a reflection of the political stance and what the nation at large believes in.

    M.Q. (China):

    In regard to professional training and advancement of the professionalization process, the United States is at the forefront of many countries. When we have established registration systems, we refer to the United States and the relevant experience of other developed countries and regions, and also take into account the national conditions of China. A lot of things in China are ruled by the Government, such as the setup of academic disciplines in colleges and universities, and inspection of teaching in universities. The professional organizations are not authorized to manage this. Many things need a lot of effort, to go for it, to push, or find a workable, and when need be compromised, channel. For example, the professional association cannot be established yet, but the work of managing the profession still needs to be done, so it is done by an existing committee; we do not have authority to do certifications and examinations, examine the capacity of professionals in other ways, or start registration.

    In short, there must be a professional management system and establishment of a professional code of ethics to ensure the healthy development of the industry as a whole. In this regard, the registration system work we have done might provide some insights to colleagues in the similar process across global settings.

Discussion

A reassuring tone throughout the literature and in the responses from the global contributors is that client welfare is the driving force behind every perspective, regardless of how different those perspectives appear. Counseling is first and foremost a field concerned with client welfare and should be willing to grow slowly if that is required to protect clients’ interests. All of the global contributors also shared the perspective that professionalization is important in their countries. The reasons for valuing professionalization include: increased public demand for mental health treatment options, client safety, consistency in training, job creation and distinction between counseling and other mental health professionals.

Challenges to professionalization were also mentioned by all of the contributors. The challenges shared echo Bergman’s (2013) article on the legal challenges to developing a profession. Laws and regulations take a great deal of time, and they must occur at multiple levels (local, regional, national). There are competing interests from other professions who perceive counseling as either a threat or as not clearly defined enough to warrant licensure and recognition as a profession. However, a lack of recognition can lead to: minimal resources for education, confused public perception, lack of collaboration and/or competition from other health professions, and unclear paths for those entering the field. These challenges reinforce the need for collaboration and patience. They also reinforce the need for all counselors to be engaged in the professionalization process. It takes numbers to effect change, as a few leaders cannot forge the path alone.

Practitioners need to constantly learn about the steps required to professionalize the field and be advocates at whatever level they are able. Practitioners should advocate to the public through their personal networks (i.e., informing others about what they do and explaining the differences between counseling and other mental health professions), voting and advocating for legislation that promotes the field, participating in regional and national networking organizations to stay informed and connected to others in the field, and constantly educating themselves by consuming and producing counseling research.

Identified are steps individuals can take to support the professionalization of counseling, based on the information provided herein, and there are steps that relate at the national and/or institutional level. The following is submitted as a possible roadmap for counseling leaders around the world: (1) identify and engage interested parties early (being sure to include voices from the public, clients, lawmakers, regulatory agencies, accreditors, practitioners, and educators); (2) cultivate a strong, shared professional identity; (3) communicate that identity through public education, collaborative relationships with other health professions, and education systems for those entering the field; (4) standardize naming conventions, measures of competence, licensure and regulations across states/regions for consistency, public understanding, and portability; (5) promote and support research while consuming research from counselors around the globe; (6) define the target market early in terms of ability and willingness to pay to establish the viability of the profession; and (7) maintain client wellbeing as the driving force behind all decision-making (including theory, practice, laws, regulations, education, licensure, payment, and research).

Further research should be conducted to more clearly define the steps needed and resources available to complete each of these tasks. Research should also be conducted to more directly engage the public in understanding how counselors and counseling are perceived and the public’s perception of barriers to the professionalization of counseling. Finally, research about how to effectively teach professionalization to new counselors would help create systemic change.

Differences in contributor responses help to illuminate the value in sharing perspectives from multiple countries. Standardization is a natural part of the growth process of a profession. Therefore, in question 6, for example, the representative from Canada is able to provide an in-depth picture of the standardization process before discussing the freedom that is still possible through the valuing of the therapeutic alliance and “the art of counseling”. Whereas, countries with little or no standardization have very little to say about the influence of standardization on the creativity of counseling because they would only be able to speculate at this stage. Similarly, the representative from Botswana noted, in her response to question 7, that countries with a more established counseling profession can learn a great deal about multiculturalism from studying the steps taken toward professionalization from countries just beginning the process. Therefore, future research should also include more cross-national research that furthers the conversation of professional identity development and growth of the profession. Research should also be done to clearly define the developmental stages of the counseling profession.

Conclusion

The challenges expressed by the contributors here are real, and these observed and experienced issues are supported by the literature. After compiling the lived experiences of industry leaders from these three countries and comparing them to our own experiences, themes emerged that outlined important steps needed to facilitate the professionalization of counseling. However, a specific guiding document clarifying the benchmarks and pitfalls of the process might be useful for all involved. Future research should be conducted to comprehensively examine each developmental level of professionalization and to determine if the steps identified here are comprehensive. The more countries that participate in this assessment, the more complete the data and the more precise the guidelines will become. Further, a continuation of the conversation about the professionalization process can be facilitated through online formats among professionals across the globe. Web-based access can equalize access to information and resources. As information, lessons learned and guiding resources are shared, the professionalization process can become more efficient and effective for subsequent efforts.