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counselors have faced legal challenges when they have diagnosed mental health problems (Remley & Herlihy, 2001). Consequently, professional counselors in some states have tried to

amend their licensing regulations to include diagnosis as one of the explicit functions of their


For example, in February 2002, the Missouri Legislature introduced a bill (House

Bill 1843) that would change the professional counseling statutes to include diagnosis, among

other counseling functions (Missouri Legislature, 2002).

In addition to the challenges that professional counselors can face in obtaining reimbursement from private insurance companies, securing public reimbursement through Medicaid and Medicare is a significant issue. Currently professional counselors are not considered eligible providers under Medicare and cannot be reimbursed for their services (ACA, 2001). Reimbursement by state Medicaid programs is not uniform, and many states do not include professional counselors as Medicaid providers. Efforts to increase the number of states that reimburse professional counselors are an on-going political struggle. For example, in 2001 the Mississippi legislature introduced a bill to amend Medicaid regulations to permit mental health services provided by licensed professional counselors to be reimbursable, however this bill (House Bill 198) died in committee in January of 2001 (Mississippi Legislature, 2001).

Marriage and Family Counselors Origins of the Profession

Marriage and family therapy began as preventative classes and courses to meet the normal needs of people, especially women, who wanted to know more about marriage, parenting and family life (Thomas, 1992). As colleges and universities began to admit their first female students, in the early 1900’s, these students requested courses on the family. In 1908, 20 colleges offered such courses, with a focus on prevention and promoting the physical and emotional health of the family. In 1924, Ernest R. Groves taught the first parenthood course for

credit at Boston University (Thomas, 1992). biological, psychological, and social elements

Groves’ subsequent work pulled together the of marriage in a practical manner and began a

trend of looking at marriage and family life from a Association of Marriage Counselors (AAMC) was

holistic perspective. In 1942, The American formed and Ernest R. Groves became the first

president. From the very beginning, AAMC emphasized the marital relationship and the value of conjoint marital therapy, marking the beginning of unique profession (Thomas, 1992). In 1963, California was the first state to legally recognize marriage, family and child counselors (Levison, 1995). In 1970 AAMC changed its name to the American Association of Marriage and


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