2.1 The History of Counseling

The American Counseling Association (ACA) defines counseling as a professional relationship in which the counselor helps others “gain personal insight, develop strategies and come up with real-life solutions to the problems and challenges they face in every area of life” (ACA, n.d.). To accomplish these tasks, counselors work to build strong therapeutic rapport rooted in safety, trust, and collaboration with their clients. Counselors are known to use the Wellness Model, an evidence-based approach rooted in positive psychology designed to help individuals make choices that influence a positive quality of life (Myers & Sweeney, 2004).

Evolution of Mental Health Counseling

The history of mental health counseling, as outlined by the ACA, reflects significant social changes and scientific advancements. In the early 19th century, the moral treatment movement marked a shift from custodial care to a more humane approach, with advocates pushing for state-funded centers (often referred to as “asylums” that emphasized compassionate care. The early 20th century saw the vocational guidance movement, led by Frank Parsons, laying the groundwork for career counseling. The world wars highlighted the psychological needs of soldiers, leading to the development of psychological testing and counseling techniques.

The mid-20th century was marked by the formation of professional organizations like the American Personnel and Guidance Association (APGA), now the ACA, in 1952. This organization helped professionalize counseling and set ethical standards. The Community Mental Health Act of 1963 aimed to deinstitutionalize mental health care and establish community-based mental health centers. The late 20th century saw efforts to establish licensure and certification standards for counselors, ensuring specific educational and professional criteria were met. Diverse counseling approaches, including cognitive-behavioral therapy (CBT), humanistic approaches, and family systems therapy, expanded the methods available to counselors.

Over the last two decades, digital technology has transformed counseling practice, making telehealth and online counseling more accessible. The ACA emphasizes cultural competence in counseling, training counselors to address their clients’ diverse backgrounds and needs. Advocacy for policies supporting mental health services and the counseling profession continues to be a priority. Key figures in mental health counseling history include Frank Parsons, Carl Rogers, and Albert Ellis, whose contributions significantly shaped the field. The history of mental health counseling shows a progression from basic treatment methods to a professional, science-based field that continues to evolve to meet society’s needs.

Evolution of Substance Use Disorder Counseling

The history of substance use disorder counseling, as outlined by the Association for Addiction Professionals (NAADAC), reflects significant developments and societal changes. The temperance movement in the late 1800s first brought attention to substance use issues, advocating for moderation or abstinence from alcohol, laying the groundwork for the founding of Alcoholics Anonymous (AA) in 1935 by Bill Wilson and Dr. Bob Smith, introducing the Twelve-Step program that has since become central to many recovery programs. Post-World War II America saw increased attention to mental health and substance use disorders among veterans, leading to the establishment of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in 1970 and the National Institute on Drug Abuse (NIDA) in 1974.

During the 1960s, formal substance use disorder treatment programs began to emerge, combining medical and therapeutic approaches. In 1972, NAADAC was established to professionalize the field of substance use disorder counseling, setting standards for education, certification, and ethical practice. The 1980s, marked by the “War on Drugs,” led to increased funding for treatment and prevention programs, though also brought controversies related to criminalization policies. The 1990s saw a shift towards evidence-based practices, with CBT, motivational interviewing, and other scientifically validated approaches becoming more widely used.

In the 21st century, there has been a growing recognition of the interconnectedness of mental health and substance use disorders, leading to integrated treatment approaches. The opioid epidemic of the 2010s spurred efforts to improve access to treatment, reduce stigma, and develop new interventions like medication-assisted treatment (MAT). Advances in technology have also transformed the delivery of counseling, with telehealth services expanding access to treatment, particularly in rural and underserved areas. Like the ACA, NAADAC emphasizes cultural competence and training counselors to address their clients’ diverse backgrounds and needs, including race, ethnicity, gender, sexual orientation, and socioeconomic status. Overall, the history of substance use disorder counseling reflects a journey from early grassroots movements to a professional and evidence-based field, continually evolving to meet the needs of those affected by substance use disorders.