The problem, which Aaron is trying to conquer while others mostly ignore, is California's Labor Law. Depending on whom you ask, it might prohibit marriage and family therapist interns from paying their employers for supervision; if it actually does (CAMFT argues otherwise), then a significant number of clinics around the state would be in violation.
But the supervision issue could be only the beginning. Mental health clinics are no different from any other business in the eyes of state labor law. But when was the last time a clinic required its therapists to take at least a 10-minute break every two hours, or mandated a lunch break for shifts lasting beyond six hours? Each of those is a labor law requirement.
At the October 2009 meeting of the Board of Behavioral Sciences (BBS), the licensing board's counsel was clear: Those who employ MFT interns are subject to labor laws just like any other employer, and "there is no scenario under which it would be appropriate for a supervisee to pay an employer for supervision." The BBS has since elaborated on that position here. CAMFT has since put forth its contrasting interpretation of the law, arguing that it is perfectly legal for an intern to pay their employer for supervision, as long as the terms of the arrangement are agreed to by both parties, in writing, in advance.
It is the Labor Board's opinion -- or perhaps ultimately a judge's -- that matters. And so far, the Labor Board has chosen to stay away from the issue, politely rebuffing requests to attend BBS meetings or issue any written statement on the question. For the Labor Board to address this issue directly, it appears, they will have to face a complaint from a disgruntled supervisee.
And that has been Aaron's frustration. He doesn't want to run his clinic in constant fear of becoming the test case. CAMFT has hinted that they might try to clear up the issue through legislation, but the odds of getting a bill passed if it looks in any way like a weakening of, or exemption from, state labor laws is slim.
Without a clear set of guidelines, what is an employer or agency to do? The lowest-risk approach appears to be to abide by the BBS stated opinion: Assume MFT interns, when they are employed (as opposed to volunteering), are subject to all labor laws, and act accordingly. In practical terms, this would require an employer to go the extra mile to make sure that interns are taking adequate breaks. Do not have interns pay for supervision. Ensure that, however interns' pay is computed, it amounts to at least minimum wage once all the intern's time (including time spent on supervision, marketing, administrative tasks, etc.) is taken into account. (Of course, I'm not a lawyer, so please do not construe this as legal advice; any employer with questions about labor law or its application should consult an attorney.)
The problem for Aaron, and anyone else trying to run a therapy business honestly, is that even if he chooses to play by all of the labor law rules, plenty of other employers are not. If Aaron abides by the labor law, he will need to either pay his employees less, or charge his clients more, than similar clinics. The extra burden could be enough to make his clinic, as a business, unsustainable. Until at least one disgruntled intern makes a test case out of it, those who disregard the labor law appear to be at a competitive advantage.
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13 comments:
Amen! I was thinking about this very thing a lot today. I even wondered, "I wonder what Ben's take on this is?" Sounds like it's the same as mine -- I'm not sure. :)
Very interesting regarding the labor law. I had wondered about that myself. Also, in regards to, if that is included in the payment cut arrangement between therapist and intern. Is that considered paying or not? Because it is technically a deduction in original pay, however, you are also paying for other things...office use, etc. (But on paper it might not appear as though you are directly paying for supervision,even though included).
@Shannon - Great question! If an employer covers the cost of supervision by paying the supervisee a lower wage generally (i.e. a lower hourly wage that ensures the employer has enough to cover supervision in addition to other overhead), that would appear to be legal -- the issue is when the employee is specifically paying for supervision, whether by making a separate payment or having a specific supervision fee deducted from their paycheck. ...that said, standard caveat: I'm not an attorney, and any questions about how to apply labor law should be directed to someone who is.
Ben,
Wonderful discussion of the money contradictions in the way this is all being interpreted. Another facet of this same issue is the BBS regulation that says that interns can work as volunteers in a for-profit business, under a private practice internship.
However, this is in clear contradiction to California labor laws. It is leaving private practice supervisors and interns in a difficult position.
I, and many other clinical supervisors are taking a more conservative approach, and not taking on volunteer interns, but that leaves less positions for interns.
Unless I have a waiting list of clients to start week 1 of a private practice internship, I can't reasonably employ them.
So many questions... and I have to say- I think the most confusing aspect of the law isn't the law- but it is the fact that the professional association is the only one that is saying volunteers in private practice and paying for clinical supervision is ok.
I understand that this is an attempt not to "lose any ground." However, I am just not sure if standing our ground on this issue is truly the way to go.
Miranda Palmer, LMFT
http://mftguide.com
Timely topic.
I Recently interviewed, (and was interviewed by) a few new prospective supervisors, as I was considering a change from an agency to private practice, being half way through the licensing process.
Some were not aware that paying for supervision was not OK.
Ultimately, I went with one of the few who knew the right answers, when I asked the questions.
Ben - this highlights an issue that has interested me since moving to California. In other states, it is possible for an AAMFT Approved Supervisor to supplement their private practice or other employment income by offering supervision toward licensure to post-MA candidates. In Colorado, these candidates registered as unlicensed psychotherapists and thus did not have to be attached to a particular supervisor.
In California, with the tight attachment between MFT intern and supervisor, this seems to prevent any opportunity for such supplemental income. This is also a consequence of the fact that the BBS does not require MFTs to be supervised by Approved Supes. I feel rather angry that with my 7+ years of licensure and 5+ years of Approved Supe credential, not only can I not earn some extra income by providing supplemental MFT supervision, I can not provide *any* supervision until I have been licensed here for two years! Essentially California has made my rather expensive credential nearly useless.
I'm not a Libertarian and never will be, but this is one instance where their rhetoric about government "takings" gains a little purchase with me. As if the lack of reciprocal licensure isn't enough of an insult to long-time professionals, they also undermine our supervisory credentials too.
Hi Sheila,
I read your post and can empathize with your situation.
Was confused about (if I read this correctly) "...the BBS does not require MFTs to be supervised by Approved Supes."
All of my supervision has been provided by both licensed and supervision-credentialed Therapist.
I can't speak for her, but I suspect Sheila is referring to the requirement in many states that MFT Interns be supervised by an AAMFT Approved Supervisor. With that requirement, the Approved Supervisor designation is a truly portable credential. However, California does not recognize it, and indeed the standards to supervise MFTs in California are much lower than in most other states. More information: AAMFT Approved Supervisor designation.
I'm glad to hear this. I've always found it deeply insulting that MFT interns don't even get minimum wage and then are expected to pay for supervision. 16 year-old delivering pizzas get more than minimum wage! I hope this message gets out more. I don't feel sorry for the supervisors. They usually charge at least $50/hour for clients to see interns. They can pay the interns the California minimum wage of $8/hour and STILL make a lot of money off interns.
Let's be honest. There are more MFTs going into the system than can be absorbed by paying clients. Is the therapy business model sustainable? Let's not balance the books on the backs of the poor beleaguered intern.
@Anonymous (June 24 posting) - I would like to see data to support that claim. Yes, a lot of new therapists are coming into the health care system... and a lot of older therapists are retiring or at least cutting back hours. There remains ample evidence of a work force shortage in mental health. There's some great discussion to be had about the future of the *private practice* business model, and also great discussion to be had about how mental health services can be funded. But I have yet to see good data that supports a pessimistic point of view.
This is very interesting. I got on your blog to find out about supervising interns in private practice and found you talking about the future of private practice and how it and mental health in general can be funded in the future.
A couple of months ago I got together with some other therapists with these same concerns. We decided that the best way to fund mental health in the future is with a Single Payer Health care system. We formed Therapists for Single Payer and are working to get a bill (SB810) through the California legislature to set up the frame for such a system. We put on a very successful symposium for therapists on Oct. 29. It drew AAMFT and CAMFT board members as well as MFTs LCSWs Psychologists and Psychiatrists to the audience. I truly think that our only hope is to kick out the insurance companies with their reams of paper work and high overhead. I can't imagine a worse way to provide services to people than to put a big lumbering company that provides no services in between the the client and the professional. www.therapistsforsinglepayer.org
It can be such a double bind for us interns, that the few jobs avialable for us we have to pay for supervision, we are then told that we need to have the ability to charge the client and to be able to talk about money and to work through any issues that come up around money.At the same time the 3000 hours are hanging over our heads. Having the two parties 'agree' doesn't account for the power differential that is occuring within the relationships.
Thank you for the article, it is something that I needed to read!
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