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As we entered into the 21st century that is when clinicians are using piles of the first, second, and third force for treatment purposes. Clinicians are becoming more aware components of individuals. These consist of gender, race, culture, etc. Clinicians are using these components to help determine treatment plans. Having knowledge in multicultural issue and being culturally competent are key components to "The Fourth Force". The counseling profession is continuously changing and it is important for clinicians to stay up to date on research and new approaches that may be uprising.

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Carl Rogers work appeared in the 1960's. He led "The Third Force" with his work. Two other theorist that contributed to "The Third Force" were Fritz Perls and Viktor Frankl. Their worked focused on emotions and sensations of individuals and helping people find meaning to their life.

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Other theorists that had part in the "second force" of psychotherapy included B.F. Skinner, Albert Ellis, Aaron Beck, William Glasser, and Donald Meichenbaum. These theorist introduce behavioral and cognitive theories and interventions. Behavioral approaches were used greatly in the 1970's where as in the 1990's cognitive approaches were used more often.

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Development of psychodynamic approaches to psychotherapy came from Sigmund Freud's work. This made a good foundation for the psychotherapy field. This was known as the "First Force" of psychotherapy.

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Mental health issues had a negative stigma associated with it during this time period. Many people had very serious symtoms and treatment for these issues was limited. Many individuals were placed in institutions in which the treatment plans were ineffective