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What Does a Mental Health Counselor Do?

The goal of a mental health counselor is to assist their patients in achieving positive mental health with emotional well-being. They help individuals to manage, and even overcome, different emotional and mental health disorders in addition to helping with family and relationship issues.

A counselor’s job is to:

  • Listen to their patients
  • Ask probing questions
  • Help the client better understand their issues
  • Develop strategies that will improve the patient's quality of life

Mental health professionals can work with a variety of patients in different ways. Some mental health professionals specialize in specific types of therapy, including but not limited to the following:

  • Behavioral Therapy - Helping patients unlearn or change negative behaviors
  • Cognitive Behavioral Therapy - Often used to treat phobias, addictions, and obsessive-compulsive disorders
  • Person-Centered Counseling - An accepting, supportive treatment style full of encouragement and warmth
  • Psychoanalysis - Helps the patient become aware of their unconscious patterns to create changes
  • Psychodynamic Counseling - This technique depends heavily on the therapist-client relationship to assist the patient in creating the psychological tools necessary to handle complicated situations and feelings
  • Interpersonal Counseling - This approach focuses on the disorder being considered a medical illness that needs treatment

Who Do They Work With?

Licensed mental health counselors work with everyone. The licensed mental health counselor office is a place of acceptance, support, and understanding for all. There are many reasons someone may need to seek the help of mental health professionals.

Here are some of the reasons people choose to reach out:

  • Feelings of unhappiness, irritability, or sadness a lot of the time
  • Frequent feelings of being overwhelmed, worry, anxiousness, or nervousness
  • Struggling emotionally, and this interfering with daily functions
  • Thoughts of self-harm or harming others
  • Battling addiction or having a loved one who is
  • A major life change or a loss
  • Eating disorders or body image issues
  • Any abuse at any point that is still impacting life today
  • Struggle with communicating effectively with other people
  • Having a hard time with sexual orientation or that of someone else

Why Do We Need Mental Health Counselors?

When people think about their health, they often think only of their physical well-being. That oversight can be very damaging, as many people suffer from mental health issues that can be just as serious as the worst physical diseases and impairments. The National Alliance of Mental Health estimates that one in every five Americans deals with some type of mental illness every year. Of those, around 10% are serious mental illnesses that cause significant problems, interfering with everyday life.

A mental health professional can help most people gain a better quality of life. Studies have proven that the use of mental health services helps to reduce diseases caused by stress or anxiety in addition to substance abuse.

A lack of treatment can cause life to be unbearable for those with a mental illness. When treatment is sought in a timely fashion, a licensed mental health counselor can help save lives while improving the outcome for many people who feel they are hopeless or lost. It’s crucial for those dealing with a mental illness to take action and seek recovery help by reaching out to a licensed mental health counselor right away.

What Issues Might Mental Health Counselors Deal With?

More than 26% of adults are affected by a mental illness every year. Licensed mental health counselors frequently work with the following mental health issues:

Trauma: Someone who is suffering from physical, emotional, or psychological difficulties can actually seek a trauma specialist.

Addiction: An addiction counselor specializes in assisting patients in overcoming their reliance on alcohol, drugs, sex, and other damaging behaviors.

Sexual Assault: Through the study of the case history, patient interviews, and observation, a sexual assault counselor assists the individuals in adjusting and developing in all aspects of their life.

Disorders: Mood, eating, and personality disorders are commonly treated by licensed a mental health counselor. Depression and bipolar disorder fall into this category.

Phobias: There are many phobias mental health professionals treat. Some are social and others include claustrophobia, acrophobia, and autophobia.

Behavioral: Oppositional defiance, attention deficit, conduct, and anger disorders, which are common in children as well, can be effectively treated with therapy.

Psychotic Disorders: Counselors can also help with mental issues like schizophrenia, delusional disorder, substance-induced psychotic disorder, and paraphrenia.

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How to Become a Mental Health Counselor



To become a licensed mental health counselor, an associate degree will not suffice unless it satisfies the first two years of a four-year degree. A counseling bachelor's degree is necessary to move forward in this field. It also opens the door to earning your master's degree, which is required for full licensure. Areas such as psychology or sociology may be acceptable degree fields of study for this specialty, though that could change depending on the state in which you are looking to achieve licensure.

In this program, you can expect to study courses like General Psychology, Theories of Personality, Abnormal Psychology, and Human Development.


Students who decide to earn a graduate degree in the mental health field are expanding their knowledge to better help their future patients with mental and emotional issues. Individuals in the master's program gain additional knowledge through residencies, internships, as well as coursework and practicums.

Earning a master’s is a requirement to be a legally licensed mental health counselor.

In this program, you can expect to study courses like Child and Adolescent Counseling, Mental Health Counseling Approaches and Interventions, Applied Research and Program Evaluation, Counseling and Advocacy with Diverse Populations, and Introduction to Clinical Mental Health Counseling.


A master's degree covers the majority of the requirements in most states to become licensed mental health counselor and is a big part of obtaining a license. With a master's degree, individuals can become a licensed mental health counselor. They are not, however, able to become mental health counselor and they may have trouble getting into higher level positions within academia.

It’s not necessary to move out of the field of psychology to open your own practice but is an option. It’s recommended to stay in the psychology field if you plan on going into research. If you desire to do more than have a private practice, a doctoral degree is a requirement for higher-level jobs like those in a university, school system, or a hospital.

In this program, you can expect to study courses like Theories and Methods of Counselor Education, Applied Social Psychology, Theories and Methods of Counselor Supervision, Statistics and Research Design, and Research Design: Special Topics.


Every state has a set number of hours an LPC must work in a clinical environment under board-approved supervision before taking the licensure exam. The number of hours varies greatly from state-to-state. In general, you can expect to conduct at least 2,000 to 5,000 hours of counseling after completing your master's degree, under supervision or working with an already licensed psychologist, before you will be allowed to take the exam. Depending on your state, you may have additional requirements for your hours, including how much direct client contact you have and experience in a variety or specific type of clinical settings.

Sometimes the clinical hours can be done during a master's program but that is not the standard. If you desire to work in a school setting, you may need to complete additional programs approved by the National Council for Accreditation of Teacher Education.


Because the exams are administered by state boards and not a national organization, the requirements for licensure vary by state.

This is a general idea of what is required for licensure:

  • A master's degree from an accredited school in the counseling field or other related field
  • Complete required internship and practicum hours
  • Pass a national examination
  • Pass your state’s examination
  • Complete postgraduate clinical hours as required by your state

There are two national exams available. Which one you will need to take depends on your state's requirements.

The tests are:

The National Counselor Examination (NCE), which is a multiple-choice, 200-question test that takes just under four hours to complete. It covers eight main areas of counseling. This is the most common test states require.

The National Clinical Mental Health Counseling Examination (NCMHCE) has a different set up than the NCE. It takes the test taker through ten different clinical simulations to ensure competency on a broad scale. If you want to become a Certified Clinical Mental Health Counselor (CCMHC), expect to take this exam to become board certified. If you learn this is the test you will take, there are study guides available to help you.

Both exams are offered in each state by the National Board for Certified Counselors. Students who have met the requirements in training and education will be eligible to take the necessary test their state requires. There is often a fee to take these exams, and scores are typically received a month after completion.


In the interest of public safety, there is a standard established requiring licensure or certification for all health and human services professionals. It’s required by law in each state as well as Puerto Rico and the District of Columbia, for individuals to be licensed to practice legally as a counseling professional.

If you have completed the educational and examination requirements but not the supervised experience, you may be mandated to obtain an associate license rather than a full license. Your title could be Licensed Associate Counselor, Licensed Graduate Professional Counselor, or counselor-in-training.

To maintain your license, many states require professional counselors to continue their education through additional credits every one to two years. Check with your state regarding your renewal requirements.

Practicing Without a License

If an individual is practicing therapy or counseling without the necessary licensure, a licensing board may discipline the therapist or issue an injunction against their practice. The board can also send the case to law enforcement for criminal or civil prosecution.

If an individual is using a title such as MD, psychologist, or licensed professional counselor, but they are not licensed, it can be reported to the board or law enforcement immediately. Even if the counselor did not use a specific title, if they performed services that fall under those titles or a board jurisdiction, an injunction can still be sought against them and there could still be criminal or civil ramifications.

Where Do Mental Health Counselors Work?

A mental health counselor works with clients struggling with behavioral, emotional, or cognitive issues. They can work with people one-on-one, in groups, or as families to deal with mental health concerns and assist in creating mental well-being.

You can find mental health counselors working at any of the following settings:

  • Hospitals – They help families and patients learn to cope with complex diseases and work through the anxiety and depression that is often associated with a diagnosis.
  • Social Service Agencies – They help improve the mental health of the client through counseling, without the added community responsibilities of a clinical social worker.
  • Government Agencies - Counselors at a government agency could perform duties like testifying in court, interviewing victims or suspects, counseling military children, and helping veterans with PTSD.
  • Clinics – Counselors in these facilities diagnose, evaluate, and determine patient readiness for treatment.
  • Schools - A school counselor is mindful of the mental health needs of the students and offers awareness and advisement as well as support and short-term counseling. They also provide referrals for extended support and community assistance.
  • Private Practices - Individuals who decide to open a private practice can choose the kind of patients they will see as well as the method of counseling or treatment they prefer.
  • Community-Based Health Centers - Here, a counselor will perform regular counseling duties in addition to some that are unique to this position. Some of these duties are helping clients schedule doctor appointments and teaching them how to use public transportation or other community services.
  • Correctional Facilities - In this setting, counselors provide education, evaluation, and counseling to help prepare inmates transitioning to life outside of prison.
  • Businesses - Some companies hire on-site therapists to help promote the well-being of their employees and the work environment. This is often a free service for the staff provided by the company.


The salary for a mental health counselor is about $32,000 at the beginning of your career. It progresses to around $49,053 in mid-career. By the later stages of your career, you can expect to earn approximately $67,000.

The salary range can vary greatly based on many factors. That includes your level of education, certifications acquired, additional skills you may have, as well as how long you have spent as a professional counselor.

Another aspect that influences your salary is your location. The following are some of the highest paying cities and states for the mental health counselor profession.

These states or districts pay the highest salaries ranging from $62,130 to $79,130:

  • New York
  • Connecticut
  • New Jersey
  • District of Columbia
  • Hawaii

Here are the highest paying cities if you are a mental health counselor with salaries ranging from $73,720 to $84,990.

  • Oxnard, California
  • San Luis Obispo, California
  • Napa, California
  • Trenton, New Jersey
  • Vallejo, California


Employment of mental health and substance abuse counselors is projected to grow over the next decade at a rate of 25%. That is faster than all other occupations on average. This rate is due to the increasing number of people seeking mental health and addiction services.

Many states are opting for treatment options and counseling for drug offenders in place of jail time. The justice system has realized substance abuse and addiction-related offenses are less likely to reoccur by the same offender if they receive treatment. That has resulted in many sentences requiring offenders to get treatment and counseling. Research has also suggested that this is more cost-effective than incarcerating individuals. Additionally, many military veterans also need counselors to assist them with mental health or substance abuse struggles.

Employment prospects for mental health counselors, particularly those in substance abuse or behavioral disorder fields, are very good. The opportunities are even greater if you choose to work in a rural area or in communities that have been underserved in the mental health field.

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