CAMFT changing therapist-referral site to "Counseling"

CAMFT is rebranding their therapist-referral site as CounselingCalifornia.com. The change, and how it was announced, continue CAMFT's pattern of treating MFTs and LPCCs as indistinguishable.

In an announcement on November 1, the California Association of Marriage and Family Therapists (CAMFT) said it would be re-branding its therapist-referral web site as CounselingCalifornia.com. While their email described this as an effort largely to improve search engine optimization, it also fits their pattern of making marriage and family therapy (and the MFT license) indistinguishable from counseling (and the LPCC license). The change will take effect on January 4, exactly three days after the Board of Behavioral Sciences begins accepting applications for LPCC licensure through grandparenting.

Notably, not once in CAMFT's email announcement did they refer to their own clinical members as what they are by licensure: "marriage and family therapists." Instead, the clinicians who would gain referrals through the site (limited to CAMFT's Clinical Members, which at this time means just MFTs) were referred to only as "therapists" or "licensed therapists." The words "marriage" and "family" were nowhere to be found. The name change for the referral site, and the announcement of that change, certainly leave the door open for the site to be a referral site for both MFTs and LPCCs.

I can understand that, from an organizational-numbers point of view, it may benefit CAMFT to be as welcoming as possible to LPCCs as that license opens in California. However, CAMFT's continuing efforts to make MFTs and LPCCs indistinguishable work against the best interests of both professions, who should collaborate effectively when it benefits us (lobbying for Medicare reimbursement, for example) and be able to advance our unique professions when it benefits us (publishing journals or holding conferences, for example). The constant push to make us indistinguishable, culminating in a lawsuit against the BBS, was enough for me to finally cancel my CAMFT membership. It will be interesting to see how other MFTs who value the MFT title will respond, especially if this pattern continues.

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Another reason CAMFT likely changed the name: The existing name has earned them the unlucky honor of being regularly counted among the unintentionally worst company URLs on many a list.

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CAMFT is separate and independent from both AAMFT and its California Division.

Teen texting study an example of a researcher misleading the media

A new study connects the texting habits of teenagers with drug use and other risky behavior. Contrary to media reports, the study did not show texting to cause the teens' risk-taking.

Teenagers who send more than 120 text messages a day are more likely than their peers to engage in a variety of risky behaviors, including sexual activity, smoking, drinking, and drug use. That much we can agree on. It was the key finding of a Case Western Reserve University School of Medicine study presented this week.

Media coverage was predictably breathless:

• Texting causes health risks for teens (Chicago Tribune)
• Too much texting increases health risks in teens (WebMD)
• Teen texting leads to poor health (ABC News 4, Charleston SC)
• Bad behavior associated with texting too much (WLBT-TV)

But there is a big problem with each of the stories linked above. As compelling as these stories are, texting did not cause poor health or risky behaviors in this study. More precisely, the study did not show a cause-effect relationship. It found correlations -- associations between certain behaviors that tend to rise and fall together. It did not say what causes what.

If we know that one behavior (texting, in this case) is more common among people who also do another behavior (let's use drinking), then we can say the two behaviors are correlated. But that leaves at least three very different possibilities when it comes to cause and effect:

1. Texting causes drinking.
2. Drinking causes texting.
3. Some other thing (lack of parental supervision, maybe?) causes both drinking and texting.

A correlational study (like this one) does not tell us which of those three possibilities is most likely (the third strikes me as by far the most plausible). And reporters understand that conclusions about correlation are not especially enticing news stories. "This one thing is related to this other thing, but we do not really know what causes either one of them" makes for a lousy article.

So reporters sometimes go beyond what a study actually shows, and pull a cause-effect relationship out of thin air. In essence, they pick their favorite out of the three possibilities listed above, and run with it. They do this in spite of a complete lack of data supporting their conclusion over the other cause-effect possibilities.

That seems to be what happened here. What is unusual in this case is the degree to which the study's lead author actively promoted the made-up conclusion.

Even though the press release about the teen-texting study largely uses the right terms in describing the results (labeling behaviors as being "associated with" each other), Scott Frank, the lead author of the study, was remarkably cavalier in determining a cause-effect relationship his study did not demonstrate. He is quoted in that same press release as saying

"When left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers."

The medical school where the study was conducted is also encouraging this unsupported conclusion. The link to this study from the Case Western School of Medicine home page currently reads "Hyper-texting and Hyper-Networking Pose New Health Risks for Teens."

Frank's promotion of a conclusion his own data does not support prompted an unusually direct rebuke from John Grohol, the CEO of PsychCentral, whose own site had reported on the study earlier. Grohol wrote that Frank's conclusions about texting having negative health effects are (emphasis Grohol's)

all pure crap. You could just as easily write the following headlines:

Teens Who Smoke, Drink Also Text a Lot
Outgoing Teens Like to Do Things Outgoing Teens Like to Do
Teens Who Enjoy Sex Like to Text Too!

Scott Frank, MD, MS should be ashamed of himself.

I'm with Grohol on this. For Frank to say that texting can have negative health effects is, as Grohol put it, "sloppy at best, and unethical at worst." Frank is promoting a conclusion his study simply does not support. And some media outlets appear to be all too happy to run a story confirming parents' worst fears about teenagers and technology, even when the story and the data do not match.

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In deference to my journalist friends, it must be noted that the examples of poor media coverage above are far outweighed, in both quantity and quality, by the many stories covering this study that ignored Frank's quotes and reported his results accurately. Search "teenagers texting drinking" on Google's news site and you will find far more headlines using phrases like "linked to" or "associated with" than you will find "causes." Kudos to those writers (of both the stories and the headlines, since they are often not the same person) who understand the difference.

The benefits of COAMFTE accreditation for MFT students

In California, most marriage and family therapy (MFT) graduate programs are not COAMFTE-accredited. Here are four reasons why COAMFTE accreditation matters.

With the exceptions of California and possibly Texas, around the US most MFT programs are accredited through the Commission on Accreditation for Marital and Family Therapy Education (COAMFTE). Of the 80 or so license-eligible MFT programs in California, only seven are COAMFTE-accredited MFT programs. Without some background on professional accreditation and what it means, it is perfectly reasonable for prospective MFT students to wonder whether the benefits of COAMFTE accreditation are worth the added challenge of seeking out an accredited program.

Not everyone needs or will especially benefit from attending an accredited program over a non-COAMFTE program. But there are at least four areas where the benefits of COAMFTE accreditation are likely to be significant for many students:

• License portability. Of course, no mental health license is truly portable -- licensure is always a state-based activity, and each state has slightly differing requirements. This is true for MFTs just as it is true for LPCs and Social Workers. But one way to improve your MFT license portability is by graduating from a COAMFTE program. Most states specify in their licensure laws that in order to meet their educational requirements for licensure, you must have graduated from a COAMFTE-accredited program or the "equivalent." At least one state, Mississippi, has no equivalency allowance at all -- if you didn't graduate from a COAMFTE program, you can't get licensed as an MFT there, period. In other states, the process of demonstrating "equivalency" for a non-COAMFTE program may be fairly easy, or quite difficult. And it may require taking additional coursework. If you graduated from a COAMFTE program, on the other hand, the state presumes you have met their educational standards, and moving your license to another state becomes a lot easier.

• Quality education. Programs that undergo professional accreditation understand that it is a rigorous process that requires careful examination of the program, from both within the university and from the outside accrediting agency. It is rigorous to help ensure that any program that receives accreditation is offering a high-quality education. To be sure, there are some strong programs that are not accredited. But accreditation provides a valuable seal of external assurance that the program appears to be doing what is necessary to train competent marriage and family therapists. In California, graduates of COAMFTE-accredited programs perform better on MFT licensing exams, on average, than graduates of non-accredited programs.

• Job eligibility. The Department of Veterans Affairs has recently published its job description for MFTs, and is now hiring both MFTs and LPCs around the country. One piece of the MFT job qualifications stands out: You must have graduated from a COAMFTE-accredited program. (For LPCs, your program must have been accredited by CACREP.) Knowing that significant numbers of licensed MFTs (particularly in California) did not graduate from COAMFTE programs, AAMFT is working to have that restriction lifted, but in the meantime, it is what it is. Graduate from an accredited program, or don't work for the VA.

• Loan reimbursement program eligibility. The National Health Service Corps will repay $50,000 of your student loans if you work in an underserved area for two years. (Serve for 5 years, and they will pay back up to $145,000 in student loan debt.) There are NHSC-eligible jobs for MFTs available right now, and the loan reimbursement is in addition to salary, not in place of it. To be eligible as an MFT, you must have graduated from a COAMFTE-accredited graduate program.

Look, I'm biased. I graduated from, and teach for, the COAMFTE-accredited MFT program at Alliant International University. (I'm currently based on our Los Angeles campus, but have taught in Irvine, Mexico City, Sacramento, and San Diego as well.) I've consulted for AAMFT on California educational issues. And part of that work has been sharing with schools around the state all of the reasons why COAMFTE accreditation would benefit programs and their students. I've done all of that because I truly believe that attending (and now working for) a COAMFTE-accredited program helped made me a better therapist and advanced my career. In short, for me, attending a COAMFTE-accredited program was well worth it. As the saying goes, your mileage may vary.

AAMFT's web site offers a current list of COAMFTE-accredited MFT graduate programs.

Quitting CAMFT

CAMFT's LPCC "gap exam" lawsuit against the BBS is a waste of resources that, if CAMFT "wins," would eliminate California's legal recognition of the distinctiveness of the MFT license. I refuse to let my member dues support it.

As I reported here recently, the California Association of Marriage and Family Therapists (CAMFT, which is independent of AAMFT and its California Division) has filed suit against the Board of Behavioral Sciences, alleging that their decision to require a "gap exam" for MFTs seeking grandparenting into LPCC licensure amounts to an illegal restraint of trade.

If CAMFT loses, it would mean they wasted thousands of dollars of member dues on outside counsel and court fees.

But if they "win," the outcome would be far worse: It would eliminate legal recognition of any distinction between the practices of MFT and professional clinical counseling -- and pave the way for the MFT license to disappear completely. (Here's why.)

And either way, CAMFT's conduct around the issue has already damaged the organization's ability to work collaboratively with the BBS. [Page 50, item III on the linked PDF.]

Why CAMFT would want to win this argument, I do not know. But I know my member dues cannot support it.

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I have been an active and supportive member of CAMFT for several years. As I have talked with students and colleagues around the state, I have been able to honestly say that there is much to be proud of in the work CAMFT has done -- even this year, legislation CAMFT sponsored to clarify MFTs' roles and responsibilities around child abuse reporting has been good for the profession. Their in-house attorneys are wonderful resources, available any time. And at the chapter level, the overwhelming majority of CAMFT members simply want to be able to make a living providing providing the most effective services possible to their clients. They're great people and often outstanding therapists.

The organizational decisions CAMFT has made, though, have too often been in direct conflict with the best interests of the profession. CAMFT's struggle around same-sex marriage is well-worn territory here, and it speaks to larger structural problems that were apparently never meaningfully addressed. CAMFT has stopped publicly advocating for the complete elimination of the MFT license, but they continue to make decisions that lead in that direction -- like this lawsuit -- and I do not believe most members know just how close they have come to making it happen.

This lawsuit over a gap exam, if successful, would put the state on the record as determining there are no differences in practice between MFT and LPCC. Not only is that fundamentally wrong, but it also would virtually force the BBS to consolidate the MFT and LPCC licenses. (If there is no difference in practice, there is no need for independent licensure.) It would not happen immediately -- the process would take years -- but with a CAMFT "victory" in this case, it would be almost impossible to prevent.

I am a marriage and family therapist. Not a professional clinical counselor. There is a difference. Even the counselors say so. [See currently-third item, "AMHCA lauds..."] I should never have to remind a professional association of MFTs that this is true. And I cannot support one more dime of my money being used to chip away at what makes this profession unique and valuable.

So I am, with a great deal of disappointment, resigning my membership in CAMFT. I hope they get back on the right track at some point in the future. My letter resigning my membership, which largely repeats these same points, follows in its entirety.

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November 1, 2010

Dear CAMFT,

Effective immediately, please cancel my membership.

Over the past several years, I have gradually lost my faith that the organization’s goals and actions are truly in the best interest of the MFT profession. Your lawsuit against the BBS over the “gap exam” for MFTs seeking grandparenting into LPCC licensure only confirms that you are actively working against what is best for the field of marriage and family therapy.

If unsuccessful, this lawsuit will be a massive waste of members’ dues in a misguided cause. If successful, the outcome would be even worse: A legal determination that there is no difference in practice between MFT and LPCC (and perhaps LCSW as well) would pave the way for license consolidation. While this may be in the best interest of CAMFT as an organization (you could add LPCC members under one umbrella), it is quite clearly not in the best interest of marriage and family therapy as a profession. Independent licensure provides valuable legal recognition of the distinctiveness of our skill set and body of knowledge. A short "gap exam" for grandparenting appropriately balances the need to recognize this distinctiveness with the desire among some experienced MFTs who are otherwise prepared for LPCC licensure to obtain that distinct license.

Regardless of its outcome, the lawsuit has harmed CAMFT’s ability to effectively work collaboratively with the BBS. This was made clear when, at the September BBS meeting, several board members openly and publicly expressed their disappointment with CAMFT's conduct.

I cannot in good conscience allow my dues money to be used for efforts that work against the best interests of the profession of marriage and family therapy. I will happily rejoin if and when CAMFT (1) drops this misguided lawsuit; (2) makes a clear and public statement that it recognizes the practice of marriage and family therapy is distinct from other mental health professions; and (3) outlines and follows through on clear steps to protect, preserve and advance the distinctiveness of our profession.

Sincerely,

 
Benjamin Caldwell, PsyD

Are MFT licensing exam prep courses a good value?

Several companies offer products and services to help marriage and family therapists prepare for MFT licensing exams. These offerings may cost hundreds of dollars. Are they worth your money?

Last week, I posted a few tips for preparing for MFT licensing exams, including a list of providers of study courses and materials. I purposefully sidestepped the question of whether such products are worth the cost, which easily can add up to several hundred dollars. It's hard to know for sure.

Over the years I have known quite a few folks, including staff at California's Board of Behavioral Sciences, who hold particular disdain for test prep companies, viewing them as profiteers who make money by fostering test anxiety. The companies can do this partly because it is very difficult to measure their true usefulness. When examinees use the exam prep companies and then pass the licensing tests, it is difficult to tell whether their success came from the company's help, or whether the examinee would have passed anyway using just their own study skills. Either way, of course, the test prep company is usually happy to take credit for the passing score.

There are at least a couple of reasonable arguments to be made against using these companies to prepare for your MFT license exams. But for each argument, there is a strong counter. Here are both sides. The final decision, of course, is up to you.

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The anti-prep-company argument: If one's education was adequate and they received quality supervision after graduation, passing the exam should not require spending hundreds of dollars to re-educate oneself about how to do therapy in a way that is minimally competent.

The counter: It's an understandable argument, but ignores a couple of realities: One, quality education and supervision are pretty big "ifs." There are major differences between educational programs in how their MFT graduates perform on licensing exams, and while that is not all due to differences in the grad school experience, I suspect at least some part of it is. There are also bound to be supervisors who offer less-than-ideal supervision experiences, especially when the bar for becoming a supervisor is set low (in California, one needs only to have been licensed for two years and taken a six-hour supervision course to supervise interns and trainees). And two, whether they really need it or not, a lot of examinees say that they want the additional preparation. It solidifies their existing knowledge and helps them to go into the exams with more confidence. So, test preparation companies can provide a valuable, if expensive, service for those who feel they need or want it. Not everyone does.

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The anti-prep-company argument: Licensing exam prep companies thrive off of perpetuating the myth that there is some top-secret test knowledge that the companies have that examinees cannot get elsewhere.

The counter: While it is true that the necessary knowledge can come from the very textbooks used in graduate programs (these are typically what subject matter experts use to craft the licensing exam items), it is also true that success in testing relies at least in part on good test-taking skills. And a good test prep company will offer guidance on both specific content and test-taking strategies.

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So, are the test-prep companies right for you? There is no easy-to-determine answer. Even if we had enough data to say whether these prep programs work in general, that does not really answer the question of whether they would make a difference specifically for you. Still, the companies would do themselves and their customers a favor if they gathered and published the following data:

• Average customer improvement. For workshops and training courses, brief pre- and post-tests could help current and potential customers see just how much people are picking up.
• Retention rates. Give that post-test again two weeks after they are done with the course or workshop. If customers are not holding onto their gains, there's a problem.
• Exam pass rates. This seems obvious, but many companies do not actually collect this data. They should. Just demonstrating that the pass rates for their customers are higher than average would be significant.
• Reimbursement requests. Some companies guarantee that you will pass your exam or get your money back. How many people actually take them up on that? Even among those who do not pass, most can recognize the difference between weaknesses in their own study habits and weakness in the material they were provided.

As I said last week, use the strategies you have learned work best for you in helping prepare for licensing exams. If you do decide to work with a test-prep company, gather as much information you can before choosing which one to work with. That may mean asking them some uncomfortable questions. But if the test-prep company cannot calmly and accurately answer questions under pressure, how can you reasonably expect that they could prepare you to?