The complaint, heard often, is that licensure exams bear no resemblance to actual therapy, and reward good test-taking skills more than they reward the ability to, say, formulate a working systemic hypothesis about a family. Exams also may unfairly disadvantage those for whom English is a second language, which is especially unfortunate given the need for culturally competent mental health services seen across the country.
The first point is relatively easy to refute. Of course licensing examinations do not look like actual therapy -- they are not supposed to. They are designed to establish a floor for minimally competent practice, but they do not do this in a vacuum. The many hours of supervised experience one receives prior to licensure are a much better avenue for guiding, and ultimately ensuring, competent practice in the therapy room. Licensing exams focus on conceptualization: are you aware of state law, do you know crisis procedures, etc. Yes, these things could be tested in an in vivo process, but doing so is complicated, expensive, and extremely difficult to do objectively. So a multiple-choice exam, with all its imperfections, has a necessary and important role. Of course, test-taking skills will be rewarded; lots of events in a therapist's practice will be tests of various sorts, so I have no problem rewarding those who perform well in a structured and stressful environment.
The second point is more complex. The troubling effect an examination process can have on minority applicants is certainly seen in other professions:
[S]tate-mandated teacher testing is associated with increases in teacher wages, though we find no evidence of a corresponding increase in quality. Consistent with the fact that Hispanics have marked lower licensure scores than non-Hispanic Whites or Blacks, testing appears to reduce the fraction of new teachers who are Hispanic (Angrist & Guryan, 2008, p. 483)
Identification of factors associated with National Council Licensure Examination-Registered Nurse (NCLEX-RN) success is critical at public colleges of nursing with diverse student populations. ... Significant correlations were found between success in the NCLEX-RN and cumulative undergraduate nursing program grade point average, English as the primary language spoken at home, lack of family responsibilities or demands, lack of emotional distress, and sense of competency in critical thinking (Arathuzik & Aber, 1998, p. 119).
The easiest solution to this problem, at least as far as the exam process goes, is to offer licensing exams in multiple languages. However, there are major political and practical roadblocks to doing so. Politically, public preference for English and opposition to other languages in state programs seems to go in waves, but is unpredictable. As a practical limitation, some family therapy terms simply do not translate well to all languages, and any new version of the National MFT Exam would need to be re-normed and validated for each new language group. Looking beyond the test process itself, in some locations, the reporting responsibilities of family therapists (to report child abuse, for example) must be carried out in English, so language proficiency becomes a necessary and reasonable qualification for the license.
Ultimately, it can safely be said that the testing process (including the lengthy preparation for it that many MFTs go through) leads therapists to be more aware of the theories that guide their work and the laws that govern it. It is an objective way of establishing that the therapist's prior education and experience have provided them with at least a minimal level of competency in the profession. There is little to no scientific evidence, however, that the testing process, in and of itself, makes therapists more clinically effective.
References
Angrist, J. D., & Guryan, J. (2008). Does teacher testing raise teacher quality? Evidence from state certification requirements. Economics of Education Review, 27(5), 483-503.
Arathuzik, D. & Aber, C. (1998). Factors associated with national council licensure examination-registered nurse success. Journal of Professional Nursing, 14(2), 119-126.
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2 comments:
California continues to work diligently to ensure that the tests it's therapist must pass are as complex as possible. The ability to relate concepts and facts say nothing of one's ability to connect with and understand people, which is why many of us came into this field in the first place.
MFT Licensure testing does not raise the quality of therapist. It simply allows those who are good test takers to go into private practice. I have just taken my MFT written exam. I was unsuccessful yet again. I assure you, the test leaves no consideration for my skills as a therapist. What I find frustrating is that after countless hours of preparation, (this time through AATBS), I actually believed myself to be "ready" for the written exam. I have been an intern for years and am indeed a very qualified therapist. Just once however, I would like to see a test that is congruent with "practical application."
I stumbled upon this article while researching the pass rates. What I found was surprising; as the attempts to pass the Written exam increase the success rates decrease. I wonder, how one might explain this? In very fine print in the most popular study materials it states that they will prepare you for the National Exam but not the California Exam. Well, what then, if not experience, study, education, supervision, and AATBS will prepare you? I prayed, so in this case even God’s grace wasn’t sufficient.
Now, I have known many who passed the National Exam but experienced a great deal of difficulty with the CA exam. Of course, as with anything else, there are those who (unlike myself) pass the written exam on the first try. To be completely objective, I will have to revisit this subject after I have been successful in my attempts to pass the written examination and my feelings are not so raw. For now I will have to ask myself the miracle question, “ what will if feel like when I finally pass that written exam?” See that already I feel better.
Gigi asks a good question in her comment: Why do pass rates decrease on second attempts, third attempts, and so on?
This actually is an indicator that the test is doing what it is supposed to do: Differentiate those with the necessary knowledge and skills to pass from those without. If those taking the test the second time passed just as often as those taking the test the first time, then it would seem that passing (or not) was occurring at random. On the other hand, if you have a certain portion of the population who shouldn't pass the test, it is good (from a test administrator's perspective) to have them regularly not be passing. In which case those folks would become a bigger proportion of the group on each subsequent attempt.
Of course, many people fail the first time who do have the knowledge and skills, and just had a bad day or were unlucky. On subsequent efforts, these folks will be filtered out. (Or "filtered in," actually, since they will likely soon pass.) Gigi, I hope you're among that group. Good luck on your next attempt.
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