Thursday, March 13, 2014

Training in mental health is unreasonably long

Therapists have that in common with medical doctors.


2010-07-20 Black windup alarm clock faceJust as a quick thought experiment, go over to this piece at Slate discussing medical training, and every time it references "medicine" change that to "mental health." (Accordingly, change "physicians" and "doctors" to "therapists.") You'll find most of it applies perfectly. To wit:

Over the past century, there have been additions to, but few subtractions from, the training process. Residency and fellowship programs became longer and longer ... and longer.

The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges.

The fundamental problem here is that the argument between traditionalists and reformers [debating the appropriate length of training] is essentially theoretical — we are in an evidence vacuum.
In the time I've been in academia, I've watched as the requirement for family therapist training in California increased from 48 to 60 units based not on science but on workplace competitiveness. (MFTs were fighting clinical social workers for some of the same jobs, and since LCSWs need 60 units of training, MFTs couldn't really argue that their training at 48 units was equivalent.) I've also watched as education in general has gotten much more expensive, and loans harder to come by. And I've been enlightened by learning that our 3,000-hour supervised training requirement is based entirely on tradition, and is in virtually no way linked to the science that we now have available (though admittedly, it isn't much) on how therapist skill develops over time.

Our old apprenticeship model is broken. It's as true in therapy as it is in medicine. It will be interesting to see how experimentation with medical training goes, as it can blaze the trail for similar efforts in other health care professions like ours. I'm just not sure we should be waiting for doctors to do it first.

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Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.


Dr. Sheila Addison said...

I support the 60-hour MA, and honestly even the California program as it stands has far too little family systems theory, far too much medical and psychodynamic material, and an appallingly low standard for sexuality/sex therapy which most programs still don't even teach for a full semester.

On the other hand, the 3000 hour internship is absurd, particularly since it STILL doesn't require an MFT to complete a single solitary hour of couple or family therapy.

And given that LPCC program grads can't include any of their pre-graduate service hours in that 3000, it's doubly appalling.

Emmie Perry said...

Hi Ben- Fascinating blog post! As a current Alliant student in the Master's MFT program, the change from 48 to 60 units only leaves one thing on my mind: more student debt. While it makes sense in the long run (placing us on a level playing field with LCSWs in terms of employment), it's hard not to get bogged down with the overwhelming price of becoming licensed. Not only is there tuition, but also fees for licensure, association memberships, certifications, workshops, etc. I would be very interested in reading a blog post about student debt/the cost of licensure.

I have read your post on Money for MFTS and Finding MFT Jobs, but I've had a hard time finding support from fellow students (even licensed therapist) currently in student debt. Perhaps my feelings stem from the fact that, in my opinion, current MFT programs lack a thorough preparation for the business aspect of this field. I love everything about Alliant, from the focus on cultural competence to the real-world training. But I wish there was some more acknowledgement (perhaps even a course elective) on how to prosper as an MFT. Yes it's important to learn HOW to be a good therapist, but I believe it goes so much further than if you truly want to be successful. How do we stand apart once licensed? How do we attract a steady client-base? What are some benefits of working in an agency setting vs. private practice? Should we accept insurance? I would love to get your expert opinion to broaden my understanding and prepare me for this long/expensive (but worthwhile) journey! Thank you for your time.

Anonymous said...

I have to say that I am one who does not feel the 3,000 hours of internship is unreasonable at all. I thought so at first, when I first started on this journey, but definitely not now. I am about 250 hours away from submitting for my licensing exam and when I think of how much more ready I am now than even a year ago, I am very thankful for the additional time required. I have a private practice group ready to welcome me in the minute my license is confirmed, so I am definitely excited to get this phase over with and take my exam! But, the perspective and experience I have gained, even over these last 500 hours or so has been invaluable and I would not want to be beginning my private practice without it.