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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