States advance "conscience clause" bills in mental health

A new Arizona law, and a similar bill proposed in Michigan, would allow students in psychology, counseling and social work to discriminate based on their religious or moral beliefs.                                                                                                                                                                                                                                                                                                            

In Michigan, as I reported last week, the Julea Ward Freedom of Conscience Act has passed out of its House committee and is making its way through the state legislative process. Its core is almost identical to a portion of a larger religious-freedom-in-education bill that was signed into law last year in Arizona. That state's HB2565 includes this mandate:

A university or community college shall not discipline or discriminate against a student in a counseling, social work or psychology program because the student refuses to counsel a client about goals that conflict with the student's sincerely held religious belief if the student consults with the supervising instructor or professor to determine the proper course of action to avoid harm to the client.

The main difference in the Michigan law is that it requires that the client be referred to a practitioner who will provide the services the client is requesting. The Arizona law simply demands consultation with a supervisor.

The American Psychological Association has voiced its objections to conscience clauses generally. The California Division of AAMFT has expressed similar concerns. In the debate around the Michigan bill, testimony from Judith Kovach of the Michigan Psychological Association addressed that group's concerns about where laws like this can lead. The National Association of Social Workers and its Michigan chapter likewise oppose the Michigan bill.

I'll be honest -- as an educator, these laws scare me. They place the values of the therapist above the need of the client to receive competent services. (Can you imagine a medical student announcing that she would only treat heart attacks if the patients were white? These bills allow exactly that in mental health, just substitute "bipolar disorder" for "heart attacks.") The laws are so broadly worded that they would allow any student to discriminate against any type of clients the student does not want to treat. In Arizona, the student would need to be able to reasonably ascribe their prejudice to their religion, but the Michigan bill doesn't even require a religious basis -- by allowing a student's moral belief to rule the day, the bill would give students free rein to discriminate for any reason the student sees fit. Anywhere they are enacted, conscience clause laws will make it harder for universities to teach their students to work with diverse groups, as students could refuse to treat homosexuals, Latinos, the elderly, or any other group they devalue with absolute protection from university discipline.

For clarity's sake, I know a number of strongly religious therapists who are excellent practitioners and do not discriminate based on their religious beliefs. It is certainly not my intent to paint all religious students or therapists with the same brush; the overwhelming majority are fully competent and able to integrate their beliefs with the standards of their professions, often engaging in great personal struggle to do so. My concern is with the extremists, the ones whose beliefs are most in need of challenging in order to work effectively with diverse populations.

It is not an overstatement to say that if I were running a graduate program in psychology in Arizona, I would close my doors. I do not know how a program can teach its students about the mental health impacts of prejudice and discrimination and simultaneously allow students to engage in that very same harmful behavior simply because the student holds a particular moral or religious belief that devalues people based on their gender, age, ethnicity, or sexuality.

I am not the only one suggesting that graduate programs in Arizona will have to close their doors... or at least risk losing their accreditation. In fact, program accreditation has proven to be a handy cudgel for fear-mongering on both sides of these bills. Proponents of conscience clause legislation say that without it, religiously-affiliated schools will not be able to adhere to their religious principles and maintain program accreditation. At the same time, opponents of the bills argue that no school in a state with conscience clause legislation would be able to maintain accreditation, as schools would not be able to enforce the ethical requirements of the mental health professions with students. To date, I do not know of a single instance of a graduate program losing its accreditation in the mental health professions over its religious affiliation, but it would not surprise me to hear that some schools may have avoided the accreditation process altogether out of concern for whether their beliefs and practices would be accepted.

Specific to the field of marriage and family therapy, there is some small comfort for graduate MFT programs in that our field is not specifically named in the Arizona law or Michigan bill. A program that is named simply MFT and is not in a larger psychology or counseling program/school is arguably not covered by this legislation. And the accreditation bogeyman may not work in MFT. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), which accredits MFT programs around the country, cleverly sidesteps the issue: It includes a clear statement allowing schools the freedom to operate within their religious principles (page 3), but it does not provide any exception to the Code of Ethics for individual students.

Some in psychology are questioning whether these laws are really about conscience at all. Glenda Russell, a psychologist and coauthor of Conversations about Psychology and Sexual Orientation, argues in APA's Division 44 newsletter (page 19) that the laws are ultimately about preserving the oppression of gays and lesbians:

That framing [of this legislation as a “conscience clause”] ... privileges the actions of people who are trying to usurp years of social science research, interfere with the ethics positions and practices of the profession, undermine the right of the profession and educational institutions to set standards for training, render guidelines for practice with LGB clients irrelevant, return psychological practice to a non-scientific position, and undermine diversity efforts within and outside APA. To speak of such efforts in terms of “conscience” offers these efforts the positive connotations typically associated with acts of conscience—a moral superiority and social value that I frankly think are missing from the efforts to enact the legislation with which we are all concerned. ... [I]n the broader scheme of things, these efforts represent one part of the larger systematic attack on the psychological, social, political, and cultural progress made to secure an accurate view of and positive practices toward LGB people within the discipline and in society more generally. ... At this level, we are not talking about anything having to do with someone’s conscience. We are talking about a blatant campaign to reassert stigma.

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How long does it take to get an MFT license?

State laws vary, but typically, you need a two-year masters degree and two more years of full-time, supervised experience. Here are the steps to becoming a licensed family therapist.

                                                                                                                                                                                                                                                                                                           

If you are planning or considering a career as a marriage and family therapist, it is important to give thought to the time and money it will take to work your way to licensure. The timing of steps along the way could impact your choices for when to get married, have children, or maintain employment in another field.

Presented here are the typical steps to an MFT license and some common timeframes. The steps and timeframes listed here do not account for individual circumstances or the many state-to-state differences in licensure laws. You should check the web site of your state MFT licensing board (AAMFT offers a handy directory of state MFT licensing boards) to learn the specific requirements of the state where you want to license. I have some emphasis on California in this post because it is the state I call home, and because about half the MFTs in the country are here.

Note that a "typical timeframe" here means a common amount of time needed for those who are accomplishing that step through full-time work or study. If you build your career in MFT through part-time work or study, to allow you to balance family responsibilities, maintain outside employment, or for any other reason, naturally your timeframe will be longer.

Progression to licensure as a marriage and family therapist usually follows these steps:

1. Complete a bachelor's degree in psychology, family studies, or a related field. Many schools will be OK with a major in a different field if you can demonstrate adequate base knowledge in psychology and family development, through specific prerequisite classes, GRE subject test scores, or other means. Typical timeframe: 4 years.
    
2. Complete a master's degree in marriage and family therapy, counseling psychology with an emphasis in MFT, or a closely related field. Note that some states, like California, have specific requirements for what degree titles will make you eligible for MFT licensure. In most states, you will need to demonstrate that your master's degree program was accredited by COAMFTE (the accrediting body for MFT programs), or is equivalent to COAMFTE standards. I've written in the past about the benefits of attending a COAMFTE-accredited program, and I've also offered tips for admissions interviews at MFT programs. You might want to consider a doctorate in MFT, though it will take longer. Typical timeframe (masters degree): 2-3 years.
    
3. Complete additional supervised experience under a licensed MFT. In some states, including California, other licensed mental health professionals can supervise you as well; check with your state to see what their supervision standards are. Note that some states require your pre-licensed experience to be under an AAMFT Approved Supervisor. (A directory can be found here: Find an AAMFT Approved Supervisor.) During the time between graduation and licensure, while you are working under supervision, your state may call you an "intern" or an "associate" depending on the state. A few states use other titles. Most states require a total of 3,000 hours of supervised experience for you to be eligible to sit for licensing exams; there is some variability here, too, however. (Pennsylvania's governor just signed a bill reducing that state's requirement to 3,000 hours from 3,600.) Some states simply phrase this as two years full-time experience or the equivalent. Also note that in California, some hours gained within the master's degree program can count toward the 3,000 total needed for licensure. (Other states tend not to allow this.) Typical timeframe: 2 years.
    
4. Pass your state's licensing exam(s). California is the only state that uses its own exams rather than the National MFT Exam. Many states require a state law and ethics exam in addition to the national exam, since state laws vary in key areas like child abuse reporting requirements. While an exam itself is over in a day, the licensing board needs time to process your MFT exam eligibility application, you need time to prepare, and you will need to schedule an appointment with a nearby testing facility. I've previously offered tips for preparing for MFT licensing exams, four myths about MFT licensing exams, and some discussion about whether MFT exam prep courses are worth the money. Typical timeframe: 6 months - 1 year. Longer if you need multiple attempts to pass.

Once you make it through that last step, congratulations! The state can now make you fully licensed as a marriage and family therapist, able to work independently in a private practice if you choose.

Overall, it's good to plan for a total of at least 4-5 years from the start of your masters degree all the way through to licensure. Your time may be longer based on your circumstances; it would be possible (at least in CA) but unusual for your time to be any shorter.

In most states, the timelines for masters-level licensure are similar among clinical social workers, counselors, and MFTs. California is a noteworthy exception there: Only MFTs can count pre-degree hours of experience toward the 3,000 hours required for licensure, so it tends to be faster to get an MFT license in California than the other masters-level licenses. Licensing as a Psychologist requires a doctoral degree (typically 5 years, sometimes as short as 4) plus a postdoctoral internship (in California, 1,500 more hours, or about another year of full-time work) for a total of 5-6 years. Again, though, your individual circumstances may make your time longer. I'll write in a future post about how to be as efficient as possible on the road to licensure.

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Speaking of efficiency, there are three ways to respond to this or any post, starting from the least efficient: email me at ben[at]bencaldwell[dot]com (allows depth, but I'm your only audience), post a comment below (greater efficiency! more readership!), or find me on Twitter @benjamincaldwel (highest efficiency, achieved through force!).

Julea Ward wins court ruling, while legislation bearing her name advances

Her religious discrimination suit is returned to a federal jury. Meanwhile, a proposed law in Michigan would allow students to refuse to treat any client they chose, out of any genuine religious or moral belief.
                                                                                                                                                                                                                                                                                                           

Julea Ward has enjoyed two big victories so far this year.

For the first time, she won a court ruling in her case against Eastern Michigan University, which had disciplined her for refusing to provide counseling services to a gay client as part of her graduate practicum training. Just weeks later, legislation bearing her name moved forward in the Michigan legislature despite protests from universities and professional associations that the Julea Ward Freedom of Conscience Act would make it harder to effectively train mental health professionals.

In the court case, Ward's victory was limited but it does keep her case alive. While not making a determination of the merits of the case, the 6th Circuit Court of Appeals ruled that Ward should have the opportunity to argue that her religious beliefs were used against her, according to the Associated Press. The case will be returned to a Detroit-based federal jury.

In the Michigan legislature, the House Education Committee advanced HB5040, the bill bearing Ward's name. According to the Holland Sentinel, the bill would "prohibit religious discrimination against students who are studying counseling, social work, and psychology." That description seems a bit narrower to me than the bill itself, which goes beyond just prohibiting discrimination: it actually prohibits universities from any disciplinary actions against students who refuse to treat clients based on "a sincerely held religious belief or moral conviction of the student, if the student refers the client to a counselor who will provide the counseling or services." You can keep up with the bill's progress here: HB5040.

I wrote about Ward's case for Family Therapy Magazine a couple of months ago (full article: Can a religious therapist refuse to treat gay and lesbian clients?). She described the events that led to her lawsuit in this video for the Christian-based legal organization that is defending her:

I'll be writing more about HB5040 and other "conscience clause" legislation in the near future. In the meantime, the Pew Research Center offers a fascinating legal history of conscience issues in health care.

Update: About a week after this post was initially published, I posted another piece about conscience clause legislation.

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Share your thoughts on this case: Email me at ben[at]bencaldwell[dot]com, post a comment below, or find me on Twitter (@benjamincaldwel).

Iowa State MFT program closing; Saint Louis U. may do the same

While some family therapy graduate programs fight to survive, others open or expand.                                                                                                                                                                                                                                                                                                            

The Iowa State Daily is reporting on the pending closure of the university's marriage and family therapy program and associated clinic. While there are only four students remaining in the program, the Daily reports that the clinic continues to serve a beneficial role in the community, as one of very few low-cost service providers in mental health.

Meanwhile, the Saint Louis Beacon is reporting that Saint Louis University's COAMFTE-accredited MFT PhD program could stop accepting new students as early as next year, with plans to close completely in 2015. A document the newspaper described as a "draft memo" circulated to a faculty retreat outlined the proposed changes, which would also include the shuttering of several other programs. The university responded to the newspaper by saying the recommendations were preliminary, and faculty would have the opportunity to respond to them before final decisions are made by the university's board of trustees. Last week, the Beacon reported that the trustees took no immediate action, which could leave the door open for the targeted programs to survive.

If both MFT programs do ultimately close (and the Iowa State closing appears certain, while Saint Louis is more in the air), they would join a small but significant list of MFT program closures in recent years. Although accreditation in MFT is growing, with more than 100 programs around the country now COAMFTE accredited (hey Californians, COAMFTE accreditation matters), even these programs are sometimes threatened with closure. Last year, the University of Nevada Las Vegas threatened to close its MFT program, though the program survived after a reorganization.

Saint Louis and Iowa State would make at least the third and fourth closures of COAMFTE-accredited MFT graduate programs in recent years. Syracuse and Purdue both shuttered their MFT doctoral programs, though both continue to have strong masters degree programs. In addition, the MS in Clinical Psychology program at San Jose State University, which was not COAMFTE-accredited but had been producing graduates headed for MFT licensure, is on at least a two-year hiatus. According to its web site, the program will reopen as an LPCC program if it reopens at all.

It would be a mistake, though, to presume that means that opportunities for high-quality education in MFT are decreasing. As I mentioned above, COAMFTE accreditation is growing, and as some programs close, others open or expand. Alliant International University (where I teach) will be expanding its COAMFTE-accredited PsyD program in Couple and Family Therapy to my beautiful new hometown of Los Angeles this fall.

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Help my brain expand with your wise musings on MFT education. Post a comment below, drop me an email to ben[at]bencaldwell[dot]com, or post something to me on my ever-expanding Twitter feed.

The best MFT graduate schools

Updated for 2012.

Aspiring MFTs have lots of options -- there are more than 100 COAMFTE-accredited programs around the US, and about 80 license-eligible MFT programs (accredited and not) in California -- for graduate school. How should you go about choosing the school that is right for you?

Outlined here are a number of factors to consider. They are not listed in any particular order, as individual circumstances will dictate what becomes the highest priority. For some students, quality of education outweighs all else. For others, geography and cost will be more important.

• Quality. There are lots of ways to assess whether a program is successful in educating its graduate students. One is to look at the achievements of the program's graduates, in measurable (licensing exam pass rates, hiring rates) and nonmeasurable (faculty reputation, graduates' status and achievement in the local community) terms. You can also, of course, look at accreditation, which guarantees that a program has put itself through a rigorous quality-assurance process.
• Accreditation. As I've previously documented, MFT accreditation matters. Around most of the country, MFT students generally know this; in California, MFT students generally do not know this. Most states specifically require that your degree come from a COAMFTE-accredited program. Some will allow you to demonstrate "equivalency" with COAMFTE standards, but that is often no easy task. If you want to work as an MFT with the Department of Veterans Affairs, or if you want to be eligible as an MFT for student loan reimbursement through the National Health Service Corps, you must have a COAMFTE-accredited degree; equivalency is not accepted.
• Location. Generally speaking, you should attend a program in the same state where you intend to eventually become licensed. This is important because states have varying requirements for the education and supervised experience MFTs must have prior to licensure; schools in any given state are most likely to teach to the standards of that state, and classes in areas like law and ethics will prepare you for licensure exams in that state.
• Cost. When it comes to graduate school, cost questions are complex. It is not a simple matter of asking, "How much is the tuition?" Other factors, like scholarships, grants, work-study programs, and other financial aid must be considered, and can vary considerably from one school to the next. In addition, some areas (including California) now have loan reimbursement programs for MFTs who commit to working in public mental health or underserved areas. The next two factors also relate fairly directly to the cost of graduate education.
• Time to degree. Some programs are very intensive, to get you through your master's degree in the minimum time possible. Shorter programs mean you will be working as an MFT Intern sooner, and also are likely to be licensed sooner. This is significant for those who have finances as a concern. However, shorter is not always better. If you want to continue working full-time while you earn your master's degree, talk with potential programs about whether this is an option there, and how you may structure classes differently so you are not overwhelmed with the workload.
• Time to licensure. Outside of California, most programs require 500 hours of face-to-face client contact with clients in order to graduate. Within California, however, many programs require far less -- as little as 225 hours. While this at first may appear to be a plus (it tends to decrease the time to degree), it also means you will spend much, much more time working as an MFT Intern prior to being eligible to sit for the licensing exams. Students in California may graduate with as few as about 270, or as many as 1,300, hours of experience toward the license already completed. That's a huge range, and can mean a year or more of time lost or gained prior to licensure.
• Personal fit. The philosophies of MFT programs vary widely, with some taking a strong social activism approach, and others abiding by a particular treatment model. It is important that your own personal views of family not be in conflict with your degree program. Personal fit is also particularly important if you are interested in doing research -- you will want to find faculty members whose research interests match your own, so they can most effectively serve as a mentor to you.

Other factors may come into play as well, and it is important to find the program best suited to your priorities, whatever they may be. If I've left out anything here that you think is extremely important in choosing an MFT program, please let me know in the comments.

Update: A quick plug here for my own school, Alliant International University. The Alliant Couple and Family Therapy program offers a COAMFTE-accredited, two-year masters (MA) degree and a COAMFTE-accredited five-year doctoral (PsyD) degree at four campuses around the state: San Diego, Irvine, Los Angeles (where I teach; we are the only COAMFTE-accredited program in LA), and Sacramento (where we are the only COAMFTE-accredited program in the northern half of the state).

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Comments or recommendations on the decision-making process for prospective students? Feel free to post them in the comments, send to my Twitter feed, or email me at ben[at]bencaldwell[dot]com.

I regret that I can't tell you which of the programs you're considering you should choose; that is a subjective decision you should base on the factors above, and anything else important to you personally.

Proposed Ethics Code revision would remove MFTs' social responsibility

The proposal would eliminate three sections of the AAMFT Code of Ethics that currently call for service and responsibility to larger systems. Members have until January 31 to weigh in.
                                                                                                                                                                                                                                                                                                           

The AAMFT Board of Directors is proposing an incremental change to the marriage and family therapy profession's Code of Ethics, the guiding document that defines professional standards in the field. At least one of the proposed changes would drastically redefine what it means to be an MFT.

Some quick background: The AAMFT Code of Ethics was last updated way back in 2001, and much has changed in the profession since then. In particular, the emergence of new technologies for both marketing and service delivery has raised concerns about how to best manage confidentiality and informed consent. The AAMFT Board has known the Code was in need of updating, but did not want to engage in a full-scale overhaul of the Code at this time; that would be about a two-year undertaking. So, they instead are looking at smaller-scale changes. (Full disclosure: I chaired a Task Force, at the Board's request, looking at possible changes to the Code over the summer. The Task Force was just one of several sources of input for the Board as they developed the current proposal.)

One element of the proposed revised Code is shocking to me. It would change what it means to be a marriage and family therapist. The Board is proposing removing each of the following sections from the AAMFT Code of Ethics:

6.6 Marriage and family therapists participate in activities that contribute to a better community and society, including devoting a portion of their professional activity to services for which there is little or no financial return.

6.7 Marriage and family therapists are concerned with developing laws and regulations pertaining to marriage and family therapy that serve the public interest, and with altering such laws and regulations that are not in the public interest.

6.8 Marriage and family therapists encourage public participation in the design and delivery of professional services and in the regulation of practitioners.

Together, these are the sections that place MFTs in a position of larger social responsibility and make us accountable to the communities we serve. The removal of these sections would have far-reaching implications: If MFTs no longer need to have a place at the table when laws are being developed or altered that are not in the public interest, do we simply allow others to set for us the legal standards that govern our profession? Do we now need to stay out of the same-sex marriage debate? Is it OK for us to be ignorant of major legal issues in our field, from the fight for Medicare reimbursement to the Texas lawsuit over MFTs' ability to diagnose?

Perhaps on an even more fundamental level, we can look at the proposed removal of 6.6. Is contributing to a better community and society no longer a value of this profession? If so, I would be a lot less enthusiastic about being a part of it.

And that's the rub. A Code of Ethics is more than just a list of behaviors that can get you in trouble in a profession; it also serves as a vital statement of what it means to be an MFT. It reflects our values and desires as a professional group. One of those values, historically, has been responsibility to the communities we serve. If nothing else, devoting some of our professional activity to services with minimal return is a clear way of demonstrating through our behavior that we truly understand systems and our role, as professionals, in those larger communities.

The Board did not provide its rationale for this proposed change (or any others). But the reasons are likely not important. These subprinciples are key to my identity as a marriage and family therapist. They set AAMFT, as an association, and MFTs as professionals apart from other professional groups. Serving the community through pro bono work and involvement in policy discussions is part and parcel to being an MFT. Isn't it?

Members can review the full proposal of changes to the AAMFT Code of Ethics through the AAMFT web site (you will need to log in). Members can submit comments through January 31 via email; the address to send feedback can be found here. Whether you agree with me on this issue or not, if you are a member, please do weigh in on the full proposal. The more feedback AAMFT gets from members on the proposed changes (most of which are really quite good!), the better.

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If you're wondering, the CAMFT Code of Ethics encourages (but does not require) pro bono work. It also has language nearly identical to AAMFT's 6.7 above, about influencing laws.

Like AAMFT, I, too, appreciate your feedback. And you don't even have to log in to give me a piece of your mind. Post a comment below, drop me an email to ben[at]bencaldwell[dot]com, or post something to me on Twitter.

Many MFT programs (still) seeking core faculty

After several fairly light hiring years, many graduate programs in marriage and family therapy are hiring new faculty. Here are some of the openings, divided by region.
                                                                                                                                                                                                                                                                                                           

It's a happy new year indeed! Good news abounds for those looking for academic positions in marriage and family therapy; there have been a LOT available this cycle. And even now, many are still accepting applications. Here are a number of universities still looking (as of January 19, 2012) to fill faculty positions. In most cases, the positions would start in Fall of 2012.

Given the calendar, I'm only including listings here for openings that may still be accepting new applications. Several schools (my own, Alliant International University, among them) are hiring this year but have already closed to new applicants.

Know of additional openings? I'm happy to add to this list. Email me, or post on them in the comments.

West

In California, the Chicago School of Professional Psychology is hiring for its Westwood and Orange County campuses.

The University of Nevada, Las Vegas is hiring a pair of entry-level MFT faculty positions: visiting lecturer and academic intern. (Both are full-time, salary positions on one-year contracts).

Midwest

Bethel Seminary in St. Paul, MN is hiring a professor in MFT.

Northern Illinois University, in DeKalb, IL, is hiring an assistant professor of MFT.

East

UConn (the University of Connecticut) is looking for a Program Director for its COAMFTE-accredited family therapy programs.

Virginia Tech is hiring an assistant professor in its MFT doctoral program (though they began reviewing applicants on December 1, so they may not be accepting new applications at this time).

South

Pfeiffer University is looking for an Assistant Director for its MFT program on its Raleigh/Durham campus.

East Carolina University is looking for a Chair for its Department of Child Development and Family Relations. They're also seeking out a new faculty member for their Medical Family Therapy program.

I'm quite sure this is only a partial list, so please email me or post in the comments on other openings of which you are aware.