MFT Progress Notes

Proposed Ethics Code revision would remove MFTs' social responsibility

2012-01-23T09:30:00.000-08:00

The proposal would eliminate three sections of the AAMFT Code of Ethics that currently call for service and responsibility to larger systems. Members have until January 31 to weigh in.

The AAMFT Board of Directors is proposing an incremental change to the marriage and family therapy profession's Code of Ethics, the guiding document that defines professional standards in the field. At least one of the proposed changes would drastically redefine what it means to be an MFT.

Some quick background: The AAMFT Code of Ethics was last updated way back in 2001, and much has changed in the profession since then. In particular, the emergence of new technologies for both marketing and service delivery has raised concerns about how to best manage confidentiality and informed consent. The AAMFT Board has known the Code was in need of updating, but did not want to engage in a full-scale overhaul of the Code at this time; that would be about a two-year undertaking. So, they instead are looking at smaller-scale changes. (Full disclosure: I chaired a Task Force, at the Board's request, looking at possible changes to the Code over the summer. The Task Force was just one of several sources of input for the Board as they developed the current proposal.)

One element of the proposed revised Code is shocking to me. It would change what it means to be a marriage and family therapist. The Board is proposing removing each of the following sections from the AAMFT Code of Ethics:

6.6 Marriage and family therapists participate in activities that contribute to a better community and society, including devoting a portion of their professional activity to services for which there is little or no financial return.
6.7 Marriage and family therapists are concerned with developing laws and regulations pertaining to marriage and family therapy that serve the public interest, and with altering such laws and regulations that are not in the public interest.
6.8 Marriage and family therapists encourage public participation in the design and delivery of professional services and in the regulation of practitioners.

Together, these are the sections that place MFTs in a position of larger social responsibility and make us accountable to the communities we serve. The removal of these sections would have far-reaching implications: If MFTs no longer need to have a place at the table when laws are being developed or altered that are not in the public interest, do we simply allow others to set for us the legal standards that govern our profession? Do we now need to stay out of the same-sex marriage debate? Is it OK for us to be ignorant of major legal issues in our field, from the fight for Medicare reimbursement to the Texas lawsuit over MFTs' ability to diagnose?

Perhaps on an even more fundamental level, we can look at the proposed removal of 6.6. Is contributing to a better community and society no longer a value of this profession? If so, I would be a lot less enthusiastic about being a part of it.

And that's the rub. A Code of Ethics is more than just a list of behaviors that can get you in trouble in a profession; it also serves as a vital statement of what it means to be an MFT. It reflects our values and desires as a professional group. One of those values, historically, has been responsibility to the communities we serve. If nothing else, devoting some of our professional activity to services with minimal return is a clear way of demonstrating through our behavior that we truly understand systems and our role, as professionals, in those larger communities.

The Board did not provide its rationale for this proposed change (or any others). But the reasons are likely not important. These subprinciples are key to my identity as a marriage and family therapist. They set AAMFT, as an association, and MFTs as professionals apart from other professional groups. Serving the community through pro bono work and involvement in policy discussions is part and parcel to being an MFT. Isn't it?

Members can review the full proposal of changes to the AAMFT Code of Ethics through the AAMFT web site (you will need to log in). Members can submit comments through January 31 via email; the address to send feedback can be found here. Whether you agree with me on this issue or not, if you are a member, please do weigh in on the full proposal. The more feedback AAMFT gets from members on the proposed changes (most of which are really quite good!), the better.

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If you're wondering, the CAMFT Code of Ethics encourages (but does not require) pro bono work. It also has language nearly identical to AAMFT's 6.7 above, about influencing laws.

Like AAMFT, I, too, appreciate your feedback. And you don't even have to log in to give me a piece of your mind. Post a comment below, drop me an email to ben[at]bencaldwell[dot]com, or post something to me on Twitter.

Many MFT programs (still) seeking core faculty

2012-01-20T09:16:00.000-08:00

After several fairly light hiring years, many graduate programs in marriage and family therapy are hiring new faculty. Here are some of the openings, divided by region.

It's a happy new year indeed! Good news abounds for those looking for academic positions in marriage and family therapy; there have been a LOT available this cycle. And even now, many are still accepting applications. Here are a number of universities still looking (as of January 19, 2012) to fill faculty positions. In most cases, the positions would start in Fall of 2012.

Given the calendar, I'm only including listings here for openings that may still be accepting new applications. Several schools (my own, Alliant International University, among them) are hiring this year but have already closed to new applicants.

Know of additional openings? I'm happy to add to this list. Email me, or post on them in the comments.

West

In California, the Chicago School of Professional Psychology is hiring for its Westwood and Orange County campuses.

The University of Nevada, Las Vegas is hiring a pair of entry-level MFT faculty positions: visiting lecturer and academic intern. (Both are full-time, salary positions on one-year contracts).

Midwest

Bethel Seminary in St. Paul, MN is hiring a professor in MFT.

Northern Illinois University, in DeKalb, IL, is hiring an assistant professor of MFT.

East

UConn (the University of Connecticut) is looking for a Program Director for its COAMFTE-accredited family therapy programs.

Virginia Tech is hiring an assistant professor in its MFT doctoral program (though they began reviewing applicants on December 1, so they may not be accepting new applications at this time).

South

Pfeiffer University is looking for an Assistant Director for its MFT program on its Raleigh/Durham campus.

East Carolina University is looking for a Chair for its Department of Child Development and Family Relations. They're also seeking out a new faculty member for their Medical Family Therapy program.

I'm quite sure this is only a partial list, so please email me or post in the comments on other openings of which you are aware.

How to get the divorce rate wrong

2011-12-09T11:05:00.000-08:00

Do what a CNBC reporter did: Ask divorce lawyers.

I've mentioned here in the past that estimates of the divorce rate are notoriously difficult to make well. There's some inherent guesswork involved, unless you just wait for an entire annual cohort of marriages to reach either death or divorce. And that would take a long time. To simply compare a given year's number of marriages with that year's number of divorces is to compare different cohorts, making estimates of the divorce rate done that way wildly inaccurate.

Instead, demographers and social scientists do the best-educated guesswork they can based on past data and current trends. (Government data does not do forward-looking prediction, but rather focuses on divorces that have already occurred.) As new divorce-rate studies are released, you can keep up with them on the Divorce Statistics and Studies Blog. Reasonable people can disagree about the best scientific ways to determine the divorce rate, and there is probably some value to several different approaches. So news reporters, talking to scientists, will sometimes come up with different numbers, and that's okay. They tend to wind up in that least the same neighborhood. (That neighborhood, by the way, projects the divorce rate for people getting married this year in the low 40s, percentage-wise.)

What is not okay -- what shows rather extreme laziness in news reporting -- is to ask a scientific question of someone who is in no place to answer it, and then not bother to check the accuracy of their statement. What's even worse is when that person can directly benefit from providing misinformation.

So it went with CNBC.com in September, when reporter Cindy Perman opened her story about affairs (reprinted by USA Today) by providing an estimate of the divorce rate -- a measurable, objective, scientific thing -- helpfully volunteered by the director of the American Academy of Matrimonial Lawyers.

The problems with this are so obvious that I'm stunned the article was printed. I don't even blame the lawyer, at least not any more than I blame spokespeople from the National Association of Realtors for suggesting that any economic news, good or bad, means it's a great time to buy a home. They're lying, but that's their job. I just wish reporters would subject those claims to actual scrutiny.

Like, fact-checking.

I'll say it here again: The divorce rate in the US probably never got as high as 50%, and is currently declining. The best current estimates of the divorce rate place it in the low 40s, and the divorce rate is much lower for well-educated couples than for less-educated couples.

It's a topic taken on quite well by Tara Parker-Pope in her book For Better, which dissects the science surrounding a number of elements of marriage and divorce.

Any time you see the lazy and wrong estimate that half of all marriages end in divorce, go ahead and -- nicely -- say something to correct it. I suppose as a couples therapist I might also benefit from inflating the divorce rate, but I'd rather let facts speak for themselves -- and I think effective, widely-available therapy would bring down the divorce rate even further. It would save us all some money, too.

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If you know of egregious repeat offenders with the half-of-all-marriages-end-in-divorce nonsense, email examples to me at ben[at]bencaldwell.com, post a comment below, or send me a link to it on Twitter. Of course, other comments are always welcome.

The myth of the portable license

2011-11-17T08:48:00.000-08:00

California's new LPCC isn't any more of a "national license" than the MFT license is: not at all. Why do rumors persist that it is?

Here in California, we're currently in the middle of the grandparenting period for licensed MFTs and LCSWs who want the state's new Licensed Professional Clinical Counselor (LPCC) license. One of the most common reasons I hear from MFTs for wanting the LPCC is the notion that it, unlike the MFT, is a "national license."

Except it isn't.

For clarity: An LPCC license is no more of a national license than an MFT license, which is to say, neither is a national license at all. Both are state licenses only. Both professions now have licensure laws in all of the 50 United States (and DC), but for both, the licensing laws from state to state differ. How portable your license is -- that is, how easily you could get licensed in a new state once you move -- depends on a number of factors, including which state you move to. (For more on this, see my earlier post on MFTs and license portability.) But neither license has true reciprocity, which is automatic recognition of another state's license.

The only reason I know of that could explain the myth of a portable LPCC license is that California's Board of Behavioral Sciences is recognizing the National Clinical Mental Health Counselor Exam for LPCCs, while for MFTs, we use state-based exams. Admittedly, that can make moving into or out of California with an MFT license slightly more challenging: If you move into California, even if you have been licensed elsewhere for decades, you will need to take California's MFT licensing exams. And if you move out of California, even if you have been licensed here for decades, you will need to take the National MFT Exam (many states also require a state-based law and ethics exam) to get licensed in your new home state. But the BBS has already gotten legislative approval to restructure the MFT license exam process, and is working with the folks who develop the National MFT Exam to have that exam offered and recognized in California. So that difference between the professions will hopefully be vanishing in the not-too-distant future.

There are good reasons for some MFTs to pursue the California LPCC license. Unfortunately, the ones I hear most often from MFTs as their motivators are falsehoods, and this portability issue is a great example.

If you are interested in hearing more about the LPCC license (including debunking of more myths!), differences between the philosophies of MFT and LPCC, scopes of practice, legal and workplace recognition, and much, much more, please consider attending "The California LPCC," a presentation I'm giving with Angela Kahn, MA. Angela has helped develop the LPCC curriculum for Antioch University in Los Angeles, and is going through the grandparenting process; I helped AAMFT-CA negotiate what became the LPCC licensing bill, and I'm probably not going to go through grandparenting. So we present an informed perspective from both sides of that question. We're giving the talk at Antioch in LA this Saturday, November 19 (that one's just for Antioch students, faculty and alumni, so contact the school for more info or to RSVP). We're also giving the talk in San Diego on December 3. Use this link for more information or to register: The California LPCC, Dec. 3, San Diego.

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Your comments are always free to cross state lines. Offer them here, by email to ben[at]bencaldwell[dot]com, or through my easily-portable Twitter feed.

Boy trouble

2011-10-13T11:30:00.000-07:00

A discussion of Kay Hymowitz's Manning Up and Leonard Sax's Boys Adrift.

While men have long been stereotyped as perpetual teenagers, a swath of recent books and articles have expressed rising concern about the failure of boys and young men in the United States to achieve traditional markers of adulthood. Young men appear to be falling behind young women in educational achievement, meaningful careers, and social relationships, and often seem unmotivated to move forward in their lives.

I have been reading both Kay Hymowitz's Manning Up and Leonard Sax's Boys Adrift, two books that take jarringly different perspectives on what is happening to boys and young men in America, and what needs to be done about it.

As a social critic, Hymowitz is unconvincing. Manning Up reads like more like the off-the-rails final essay from her Marriage and Caste in America than the sharp, concise and well-supported other essays that led up to it. In Manning Up, Hymowitz far too frequently relies on anecdotes as evidence, as if Sex and the City reflected the average American woman's daily life. Manning Up displays assumptions about feminism and suggestions about men that Hymowitz never bothers to defend, like the notion that men marrying at later ages is bad for women and society. The book is not as shrill as some of its Amazon reviews would have you believe, but neither is it particularly strong in landing its argument. That argument essentially is that feminism is to blame for the struggles of boys and young men, but it is up to men to adapt to the changing world, and they're dropping the ball so far.

Boys Adrift is a welcome contrast. It frames the problems American boys are facing in the context of five causes: Video games, teaching methods, prescription drugs, environmental toxins, and devaluation of masculinity. Some of those proposed causes may strike you as questionable at first (that was certainly my reaction), but Sax lays out the research on each quite well.

Perhaps more importantly, the tone of the book is right. Sax strikes the difficult balance between objective researcher and social activist, landing somewhere in the neighborhood of a concerned, but not panicked, parent. Boys Adrift is clear and convincing, and while it makes a number of public policy arguments, it focuses primarily on what parents and family members can do to ensure their own sons are the motivated and active young men we would all want them to be.

By simply confirming what some may want to believe about men, Hymowitz is likely to enjoy higher sales. But Sax wrote the better book.

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What are your thoughts on the struggles boys are facing in the United States? Have either of these books, or others, changed your thinking? Your comments are welcomed. You can also email me at ben[at]bencaldwell[dot]com, or share your reactions via Twitter.

Can a religious therapist refuse to treat gay and lesbian clients?

2011-10-03T08:34:00.000-07:00

In 2009, Julea Ward, a counseling student at Eastern Michigan University, was in her school-assigned practicum when she was assigned a same-sex couple for treatment. She went to her supervisor and said she could not provide treatment to the couple, citing a conflict with her religious beliefs. The couple ultimately was assigned to a different counselor at the same agency, who did not have the same conflict. Ward thought she had handled the issue appropriately, as the clients received the treatment they had sought and she was not put in a position of needing to hide or compromise her beliefs. She understood the issue to have been successfully resolved.

Her graduate program, however, did not. The university began a disciplinary action against Ward, citing the non-discrimination clause of the ACA Code of Ethics. The ACA Code, like the AAMFT Code, contains two clauses that appeared to conflict in Ward’s case:

Mental health professionals do not discriminate based on sexual orientation or religion, among other factors.
Mental health professionals do not treat clients outside of the professional’s scope of competence.

Though the specific wording varies, versions of those principles can be found in the ethical codes of every major mental health association. None of the ethical codes offers specific guidance on which principle is supposed to take precedence over the other when they conflict. So when a therapist’s religious beliefs suggest that homosexuality is immoral, and that therapist is asked to treat a gay or lesbian client (or couple), what should the therapist do? Can the therapist simply refuse to treat that client?

Ward’s case, like two others with similar themes, has garnered national attention, with the ACLU offering support to the University and the Alliance Defense Fund (a legal group that works on behalf of religious students) supporting Ward. Eastern Michigan argued that they had a right to require students to practice in a non-discriminatory manner, in keeping with the ACA Code of Ethics. Ward’s attorneys argued that requiring Ward to treat gay and lesbian clients would infringe on her religious freedom.

Others on both sides of the Ward case have argued that requiring therapists like Ward to provide service to gay and lesbian clients could lead to clients receiving therapy that is at best ineffective, and at worst harmful. The case has become a focal point of tension between therapists concerned about the ability of gay, lesbian, and bisexual clients to receive competent services, and religious therapists concerned that their own beliefs might ultimately be deemed incompatible with their chosen profession.

“Therapists are often scared that their religious beliefs will be marginalized, condemned, and pathologized,” said Scott R. Woolley, Systemwide Director of Couple and Family Therapy Programs at Alliant International University in San Diego, CA. “The ethical principle of ‘do no harm’ should be an overriding principle. If there is a serious question about being able to provide competent services, the therapist should refer rather than risk harming the client.”

This view is not universally shared, however. Within the field of MFT, no consensus has emerged on how such a dilemma should be handled, and there has been no test case before the AAMFT Ethics Committee. In the absence of such guidance or consensus, MFTs, including supervisors and instructors, are left to implement the existing Code of Ethics as best they can. The result is a variety of positions on whether an MFT can ethically refuse to treat clients based on the therapist’s religious views.

One of the overriding questions in this debate is the role of context. Namely, if a religious therapist refuses to treat a gay or lesbian client, does the therapist’s reasoning matter? Refusing to treat a client based solely on the client’s race, religion, or sexuality is clearly discriminatory. But depending on whom you ask, the same religious therapist refusing to treat the same gay or lesbian client because the therapist is not competent to work with the client’s issues may be deemed appropriate.

“I believe a refusal can be ethical or unethical, depending on the context and the situation,” Woolley said. “A referral based on a therapist’s ability to provide competent services can be ethical. A referral based simply on not liking gay people is not.”

On the other hand, whether the reason for refusal is the therapist’s religious belief or their level of competence, the end result can be that members of an already-oppressed group are told that they can be turned away from care simply because they are part of that group.

“MFTs need to be aware of the message that refusing treatment sends,” said William Northey Jr., a licensed MFT and Managing Partner of N-P Consulting and Therapeutic Services in Wilmington, DE. Regardless of their supposed reasons, refusals to treat any specific demographic group bear the appearance of discrimination, and must be critically examined, Northey added.

In Ward’s case, EMU has maintained that she was applying her espoused religious beliefs selectively. Ward said she said she would willingly counsel murderers or child abusers, for example, just not gay or lesbian clients. To the university, this made her refusal to treat the same-sex couple a much more obvious case of discrimination.

What is clear is that there is risk for religious therapists who refuse treatment to specific groups of clients. An MFT or student who refuses to treat gay or lesbian clients based on the therapist’s religious beliefs may be acting in accordance with the principle of “do no harm,” as Woolley suggested, and still risk their job or degree program. Three court cases involving mental health professionals – students in two of them – highlight the potential risks.

In Ward’s case, she was ultimately dismissed from her graduate program. She sued, and in July 2010, a U.S. District Court ruling supported the university. Ward’s attorneys have said they will appeal. In the meantime, state legislators from both major parties have stepped forward to voice their support for her. State senator Tupac Hunter, a Democrat, introduced the “Julea Ward Freedom of Conscience Act,” a bill which would prohibit universities from dismissing students because they declined to counsel clients based on their religious beliefs. EMU maintains that it was discrimination – a violation of the ACA Code of Ethics – that led to her dismissal, not her religious beliefs. At one point during her disciplinary proceedings, Ward even had asked university representatives, “Who is the ACA to tell me what to do?”
In a separate case involving a counseling student, Jennifer Keeton made a number of statements in graduate classes at Augusta State University expressing her view that homosexuality was immoral and a choice. Though she had not refused service to clients, she was told she must complete a remediation plan to remain in her program. Like Ward, Keeton sued, arguing that she had a right to express her religious beliefs and that the university could not force her to change those beliefs. According to the Augusta Chronicle, university faculty testified that they were not punishing Keeton for her beliefs, and did not require her to change her beliefs to remain in the program; rather, the remediation plan was intended to help her develop the needed skills to counsel clients without imposing her values on them. A District Court judge ruled in the university’s favor in August 2010, and the case is currently under appeal.
Finally, in a 2007 case, Marcia Walden, a counselor employed by a contractor for the Centers for Disease Control, refused to treat a CDC employee’s same-sex relationship. She referred the case to a colleague who did not share Walden’s beliefs and could see the client immediately. However, Walden was quickly suspended over the incident, and was fired just over three weeks later. She sued, claiming wrongful termination. As of March 2011, she was appealing her case to the 11th Circuit Court of Appeals, according to the Associated Press.

For MFTs facing difficult choices about whether to treat a particular client or couple, the choice should be focused on the client, not the therapist, said Claudia Shields, Director of Clinical Training for Antioch University in Los Angeles. “I am not sure how a therapist can be competent if they are discriminatory,” Shields said. “Our rights as therapists are important, but in a clinical context they are generally secondary to what is best for the client.”

“The practice of psychotherapy does not concern itself with the moral, religious, or personal positions of the clinician,” agreed Angela Kahn, an MFT in private practice in Los Angeles. “Those aspects of being are for the clinician’s own therapy. When a clinician allows personal beliefs to drive therapeutic decision-making, we question overall competence, no matter the content of the beliefs.”

Regardless of whether the reasons for the referral were ethically appropriate, Kahn, Woolley, Northey, and Shields all agreed that the couple to whom Ward had refused treatment was ultimately better off with a different therapist. “I am personally not comfortable with MFTs refusing to provide services on religious grounds or any other personal value system,” Northey said. “That said, at some level it would probably be in the client’s best interest not to see someone who has a prejudice against them.”

Woolley identifies himself as Christian, and said he has seen many students struggle with conflict between their religious beliefs and their desire to provide competent service. Those students often have benefited from opportunities to explore their religious beliefs without judgment. Many attitudes and beliefs change during the developmental process of becoming a therapist, and even those that do not change need to be placed appropriately in a professional context. “I think [the Ward and Keene lawsuits] may have been avoided if faculty had sought to create a safe environment in which to explore the issues with the student,” Woolley said. Such a process, he believes, would include having the student read relevant literature and talk with other therapists with similar beliefs, to help them ultimately integrate their faith with the literature and the ethical code of the profession.

Shields is an example of a therapist whose development has included major changes in belief. “I am an African American woman from a Christian background. For a substantial period of my life I believed that same-sex intimacy was a sin,” Shields said. “Over time and after much prayer and soul searching, I found that I was not able to hold those beliefs and feel that I was engaging in the radical unconditional love that I believe Christians are called to.”

I have posted a forum about this topic in the AAMFT Community. I’ll see you there for further discussion!

Sign in with your member ID and password to www.aamft.org/Community. Click on “Forums,” then “Clinical Issues in Marriage and Family Therapy,” then scroll to the forum topic, “Can a Religious Therapist Refuse to Treat Gay and Lesbian Clients?”

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To see an earlier post I wrote on the same topic, go to "How should religious MFTs treat gay and lesbian clients?"

My humble thanks to the good people at AAMFT for their invitation to write this article, and their permission to reprint it here.

Four myths about MFT licensing exams

2011-09-12T10:06:00.000-07:00

Go ahead and be anxious about your licensing exam process -- it's a big deal! But don't buy into grumbling falsehoods about it. Test items are written by actual MFTs, and there are no trick questions.

Every person who becomes a licensed marriage and family therapist has to go through an examination process. In most states, that means passing the National MFT Exam. Many states also supplement the national exam with a second exam covering areas of state law (for example, ensuring that therapists are familiar with that state's requirements for child abuse reporting). In California, the exam process is a bit different; California MFTs must pass two state-run exams, the MFT Standard Written Exam and the MFT Written Clinical Vignette Exam. The overall content and structure of California's exams is similar to the National MFT Exam -- they're multiple-choice tests that use a combination of factual questions and case-vignette-based questions.

Regardless of what state you're in, if you haven't taken the exam(s) yet, you may be dreading them. Even if you have gone through the exam process, you may not have fond memories of it. I hear complaints about the licensing exam process on a regular basis -- most of them based on total mythology. It's as if we (quite understandably) have anxiety-based associations with our testing process, past or future, and then (far less understandably) conjure up rational-sounding but totally baseless complaints about the process in an attempt to justify those fears.

It's okay to be anxious about the process on its own merits. The exams are high-stakes; if you fail, you typically have to wait several months to try again. That impacts your standing among your peers, your employment options, and potentially your income. I still remember completing California's Written Clinical Vignette exam and feeling certain I had failed. In a matter of moments, I was mentally planning how I would explain the failure to my employer, and how I would plan to do better next time. It turned out I had passed, but the memory of those anxious moments before getting my results stays with me.

If I had failed, I wanted to blame someone else: How dare that test be too hard for me! It must be the test's fault! I'm glad I didn't take much of a walk down that road, but if I had, I would have had plenty of company. Once a rumor has started that serves to explain why the tests feel so frightening and why we feel so unsure of ourselves going into them, it is easy for that rumor to be perpetuated. Such stories are factually wrong, and ultimately do more of a disservice to future test-takers by making the exams look cruel and unpredictable. But to someone who has failed a test (or is worried they might), the stories offer comfort -- and someone else to blame. So they live on each year.

Here are the four myths I hear about MFT licensing exams the most:

There are trick questions. Simply put, a licensing exam that uses trick questions would not be legally defensible. Test developers go to tremendous lengths to make sure any potential exam item works well, through several layers of review and pilot testing. If too many people are missing a question, it gets flagged for even more review. If a question appears to be tricking people, either by design or by accident, it is removed.
There is secret knowledge. Test-prep companies make a lot of money perpetuating the mythology that they can provide you with "secrets" or other insider knowledge to help you pass the tests. Nonsense. Both California and AMFTRB (developers of the national exam) offer study guides that say what will be covered on the exams, and they ultimately draw their questions from the same textbooks and journal articles that graduate programs use to teach their students.
They are meant to assess whether you are a good therapist. If I may be blunt, your licensing board does not care whether you are a great therapist or a lousy one. They only care about whether you can practice marriage and family therapy competently enough so as to not be a danger to the public. That's what the exams are meant to assess. Yes, it is sometimes true that ineffective therapists pass their licensing exams, and effective therapists fail. But effectiveness and potential dangerousness are two different things. If you want an outside evaluation of your quality as a therapist, look elsewhere. (Back in 2008, I examined in more detail the question of whether licensing exams lead to better quality therapists.)
They are written by people who aren't therapists. Both California and the AMFTRB use licensed therapists to write their test items. In California, you can apply to be a subject matter expert involved in writing the exams. Elsewhere in the country, AMFTRB intermittently recruits MFTs with relevant expertise. Every test item on both the California and National MFT Exams is written by one or more practicing MFTs.

If you're anxious about your own upcoming exams, instead of buying into the falsehoods above, you'll likely be better off to do something about that anxiety. Maybe that means simply more studying, or maybe it means more directly addressing the anxiety through meditation, therapy, or other means. (Test-prep programs may be of questionable value overall, but if they can help you feel more knowledgeable and less anxious as you take the tests, they may well be worth your time and money.) Rest assured the exam process, and those who designed it, are not out to get you or to trick you. With the right preparation, you can do well on exam day.

If you know someone else who is anxious about their exams, or even who has failed an exam, by all means, comfort them and empathize with them. Sometimes we just have bad days. But please don't support any of the mythology above -- those ideas just make the testing process look bigger, scarier, and less under your control than it really is.

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Since we're talking about mythology, I kept looking for a way to work Greek or Roman myths into this somewhere, and was unsuccessful. So send your lightning-bolt emails to me at ben[at]bencaldwell.com, post a Herculean comment below, or send something to my Pegasus-winged Twitter feed.

MFT student alleges racial discrimination kept her from degree

2011-09-07T13:01:00.000-07:00

A former MFT student at Southern Mississippi has sued the university, claiming their discrimination made it impossible for her to complete her practicum hours.

According to a report in Monday's Hattiesburg American, former MFT student Maria Salcido has sued the University of Southern Mississippi over alleged racial discrimination. Salcido, who is Hispanic, alleges that she was told by faculty that she needed to secure a practicum working with Hispanic clients, and that the program then failed to find her such a placement. Salcido left the program in 2009 and moved to Wisconsin, though it is unclear from the newspaper report whether she left the program voluntarily or was kicked out.

Salcido appears to have completed all the rest of her academic coursework; the report indicates that both sides agree she only needs to complete the practicum to complete her masters degree. Salcido is seeking compensation, punitive damages, and the opportunity to finish her degree.

The newspaper attempted to reach the university's lawyer for a response, but had not been successful as of Monday. According to a response the university filed in court, the university and its employees consistently acted legally and properly within their professional roles, and Salcido's claims of racial discrimination are not accurate.

The case is currently at the District Court level as Salcido v Southern Mississippi et al. I'll be keeping an eye out for more information as the case progresses.

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Comments are welcome below. In addition, you can email me at ben[at]bencaldwell.com, or educate me via my Twitter feed.

The first 100 posts: A blog retrospective

2011-08-22T14:56:00.000-07:00

Like any mediocre sitcom, I'm making the 100th episode a clip show. With some data on what you, dear reader, seem to enjoy (or at least look at) the most.

When I started writing this blog in 2008, I had no idea what it would become. Looking back, I see some good ideas that stuck (talking about MFT education, California's new LPCC license, and how weird California licensing laws are seem to reliably generate traffic), some bad ideas that faded away ("Friday fun" lasted all of two weeks, and really did not live up to the title), and some could-be-pretty-good ideas that I really should return to at some point (a series of posts on fringe practices).

Today, the blog gets more than 100 pageviews a day (can I get my TV deal yet?), and more than 10,000 per quarter. Even accounting for webcrawlers and spambots, that's some serious traffic considering the fairly specific nature of the blog. It is a source of mildly-confused pride that should you Google "LPCC California," one of the first results you are likely to see is my post on whether California MFTs should dually license as LPCCs. I've been linked to by the AAMFT Facebook page and by the North Carolina licensing board, among many others.

The blog is fun to write, and hopefully worthwhile to read. I've certainly learned some things along the way about what people actually do read:

Most-viewed pages
Since July 1, 2010
1. The best MFT graduate schools
2. CAMFT sues California licensing board
3. California LPCC law passes; should MFTs dually license?
4. Finding MFT jobs
5. MFT licensure: California

And how do people get here in the first place? Why, through Google, of course:

Most common search terms leading to MFTProgress.com
Since July 1, 2010
1. MFT jobs
2. LPCC California
3. Best MFT programs
4. Top MFT programs
5. MFT program rankings
6. LPCC licensure California
7. COAMFTE

In the 99 (okay, actually 103 -- I'm a little late getting this one done) previous posts to this blog, I'm most proud of those that fill an informational need, offering students, interns, and licensees guidance in the profession that was not available (or at least not conveniently available) before. Some examples:

* AAMFT, AFTA, CAMFT, IFTA, and more: A primer on MFT associations
* Should you pursue a doctorate in MFT?
* The benefits of COAMFTE accreditation for MFT students
* Are MFT licensing exam prep classes a good value?
* Money for MFTs

I'm also particularly happy with the conversation many posts inspire. Out of the last 22 posts here, 17 have at least one comment, and some have many. The comments are fun to read, often educational for me, and one of the best parts of doing this blog.

So, with a hearty tip of the hat, I thank you, readers, for all your visits and comments, and look forward to the next 100 posts. Hopefully they'll include headlines like "MFTs to become eligible for Medicare reimbursement," "California to adopt National MFT Exam," "License portability to improve across US,"

...and of course...

"Caldwell study to receive cash award."

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Speaking of those next 100 posts, your topic ideas are always welcome. Most of the topics covered here grew from informal conversations with students or colleagues. Email me at ben[at]bencaldwell.com, post a comment, or be really succinct and send something to my Twitter feed.

Eight interview tips when applying to an MFT graduate program

2011-08-08T11:07:00.000-07:00

Don't call yourself a perfectionist, for one thing.

As the academic year begins, we also rapidly approach the time of year for admissions interviews, those high-pressure days when prospective MFT graduate students have anywhere from just a few minutes to a full day to impress their chosen programs. I have been doing admissions interviews for six years now. Along the way, I have seen marginal students get into their desired program on the strength of a good interview -- and I have seen academically strong students whose poor interviewing ultimately kept them out of the programs they sought.

There are a number of good guides out there that can help with general interviewing skills. This post is intended to highlight those behaviors that, in my opinion, can have particular (and sometimes unexpected) weight in interviews specifically for family therapy graduate programs.

Please bear in mind that all of this is simply my own opinion and experience. Every interviewer and every program is different. Still, I hope these help in your preparation. They are in no particular order. If you are interviewing soon, good luck!!

Assume that the whole time you are on campus is your interview. In other words, remain your charming, professional self even in times that seem more informal, such as meal breaks or meetings with current students. Many programs use these opportunities to gain a more complete impression of applicants, and do consider feedback from everyone who has met you in the admissions process when making their decisions.

Be specific. Sometimes, interviewees keep their answers short and simple to avoid saying anything the interviewers may find off-putting. This strikes me as unwise. The interview is the chance for the program to get to know you; take it! If you're still a mystery after the interview, they might rightly wonder how successful you would be at building relationships with other new people (namely, clients). Talk in specific terms about your skills, your goals, and your experience. If your answers lead the program to turn you down, then you weren't a good fit in that program anyway -- and better to know in advance.

Set yourself apart. A lot of candidates spend time highlighting traits that are generally positive, but common in the pool of applicants you're competing with. Talking up common strengths (like organization, multitasking, working well with others, and having a passion for the field) is unlikely to hurt you, but does little to help. Be prepared with specific examples of you demonstrating those strengths, and spend a majority of your time talking about pieces that make you unique. These might include specific work, research, or volunteer experiences relevant to the field; international or multicultural experiences that led you to develop specific skills (if you are multilingual, particularly highlight that); or other skills or experiences you have that others in the applicant pool probably don't have. The more of these kinds of traits you can highlight, the more the program may see you as a uniquely qualified candidate instead of just one among many.

If your interviewer asks what your flaws or struggles are, do not say you are a "perfectionist." It sounds at first like a good answer -- after all, it means you are driven to succeed, right? In fact, interviewers may see it as a red flag. It looks like you could be trying to dodge the question with salesmanship instead of just answering it, like the interviewee for a corporate job who says his biggest problem is that he just. cares. too. much. about the company. If you do label yourself a perfectionist in an interview, hope that the interviewers see it as a dodge; that is actually the friendlier interpretation. Because if you are telling the truth about being a perfectionist, you are admitting that you are the kind of student who suffers paralyzing anxiety at the thought of screwing up anything, large or small. That does not leave a good impression among those who would be trying to teach you. Ideally, therapists (and students) want to do well, but also allow themselves the freedom to learn from their mistakes without doing what true perfectionists do: getting defensive or down on themselves in the face of even mild criticism or failure. Simply put, wanting to do well is a desirable personality trait in an applicant. Desperately needing to be perfect is not.

Avoid platitudes. Presumably you would not be applying to an MFT program if you did not want to "help people." If you want to show your kind and generous spirit, be specific: Who in particular do you want to help, and why them? Similarly, it is safe to assume that all the applicants with whom you are competing would like to "make a difference." Using phrases like these on their own is just wasting words; they do nothing to set you apart, and if anything, they can arouse skepticism on the part of your interviewers. Be prepared to explain such statements in greater depth. Better yet, avoid the platitudes entirely and cut to the chase.

Know your interviewers. If you know in advance who will be interviewing you, look online to see what you can learn about their research interests, the classes they teach, and their recent presentations or publications. (In smaller programs, learn what you can about *all* the faculty; that way you can talk intelligently about whose interests most closely align with yours.)

Be direct and brief with any negative discussion. Interviewers may ask about prior struggles you have had, especially if they see a low GPA on your transcript or see that you left prior work positions abruptly. Family therapy faculty are going to be particularly interested in how you handled such difficult personal interactions, knowing that managing conflict professionally and respectfully is a major part of what you will be expected to do as a student and as a therapist. When discussing other people or institutions with which you have had conflict, keep your discussion of others' actions short, factual, and fair. Take responsibility for your part in the problem. And talk in specific terms about what you learned from it, and how you have put those lessons into action.

Ask questions. The admissions interview is a two-way street. A program that accepts you only benefits if you actually enroll in classes. Come to your interview prepared with at least 2-3 questions about the program (here are a few things worth asking an MFT program about), the faculty, or other students. Of course, keep time constraints in mind when determining just how much to ask about during the interview process. Understand if your interviewers can't answer all of your questions right away, or if they deflect some questions to program staff; they are under a time schedule, and no one person is likely to know every detail of program information. If they offer the opportunity to follow up via phone or email to get those questions answered, take them up on it.

As I mentioned at the beginning of this post, every program and every interviewer is different. If you have other tips you can share with future interviewees, including tips on interviewing at specific programs, please feel free to share them in the comments.

On ethics and CAMFT's record of published statements about AAMFT

2011-04-14T08:03:00.000-07:00

In their own words. All bold text is my emphasis added.

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"Marriage and family therapists, when acting as teachers, supervisors, and researchers, stay abreast of changes in the field, maintain relevant standards of scholarship, and present accurate information."
- CAMFT Code of Ethics, principle 3.5

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On AAMFT and AAMFT-CA's legislative interest

CAMFT statement: "The opposition [to the LPC bill] in California from AAMFT and AAMFT-CA never surfaced until 2007 and their legislative interest was limited to this single effort - this single piece of legislation."
- CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check 1: "Assembly bill 894, introduced last year, would create a professional counselor (LPC) license in the State of California. While AAMFT-CA has no objection to the licensure of mental health professions, we had major concerns with the content of this bill, and therefore took a position of opposition. [...] I spoke to the legislature’s Joint Committee on Boards, Commissions, and Consumer Protection in November [2005] to let them know our position and the reasoning behind it."
- AAMFT-CA newsletter, Legislative and Advocacy column, Spring 2006

Fact check 2: "Among our accomplishments in 2007, we have worked with the BBS to improve license portability into California. [...] We also helped to defeat the bill that would have created an LPC (licensed professional counselor) license in California [...] We are not opposed in principle to counselor licensure [...] We also have been very vocal with the BBS in helping shape the new educational requirements for MFT graduate programs, which are likely to be put into legislation next year."
- AAMFT-CA newsletter, Legislative and Advocacy column, Fall 2007

Fact check 3: "In 2007 the AAMFT experienced many successes on important advocacy initiatives. In particular, the AAMFT is pleased to announce that we were successful in obtaining participation for MFTs in the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA) Minority Fellowship Program. [...] Also, for the first time, the US House of Representatives passed a bill including MFTs in Medicare."
- Membership renewal message from the AAMFT Executive Director, 2008

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On working collaboratively

CAMFT statement: "CAMFT has approached the [AAMFT-CA] division about legislative issues that CAMFT is sponsoring to involve them in joining our efforts -- efforts to work together to further the interests of the profession. There has been no willingness or interest in working with CAMFT on these legislative matters."
- CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check: "With the resources I have available [through] AAMFT, I think that a joint and collaborative effort would be valuable. If you let me know when and where the meeting is taking place, I would like to make arrangements to join you."
- Email regarding counselor legislation from AAMFT-CA Executive Director Olivia Loewy to CAMFT Executive Director Mary Riemersma, March 27, 2007

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On AAMFT's interest in federal legislative matters

CAMFT statement: "Historically, AAMFT, at the federal level, had no interest in legislative matters. It was actually Richard Leslie at CAMFT who pushed AAMFT, thereby turning the tide on their involvement in federal legislative matters to attempt to advance the MFT profession."
- CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check 1: "The association not only incorporated as a trade organization in Washington, but also began a long association when it hired Steven L. Engelberg as legal counsel for Washington (federal) affairs in 1974. [...] Failing to make progress in two months of negotiations with the Department of Defense [after CHAMPUS reimbursement for MFTs had been eliminated], the AAMFT sued the DoD for reinstatement on April 26 [1975]."
- William C. Nichols, The AAMFT: Fifty Years of Marital and Family Therapy, pp. 41, 63.

Fact check 2: "CAMFT contracted with Richard S. Leslie, Attorney, in 1976."
- CAMFT Executive Director Mary Riemersma, "The building of a profession"

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On correcting false information, Part I

My correction request: "At the article’s conclusion, Ms. Riemersma writes, “No one gains by steadfastness, an unwillingness to negotiate, and casting barbs at the perceived opposition.” With this, I would agree wholeheartedly. Unfortunately, much of the Feature Article appears to be an attempt to cast barbs at AAMFT – an organization that, like CAMFT, has the best interests of the profession at heart. Even when the organizations disagree, it serves us best to present information that is clear and accurate."
- My May 7, 2008 Letter to the Editor requesting CAMFT correct the provable factual errors detailed above

CAMFT response: "Your letter will not be printed in an upcoming issue of The Therapist due to the fact that members are troubled by the debate and do not benefit from it."
- CAMFT response to my request

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On CAMFT informing the legislature (and its members) about a one-license future

CAMFT magazine: "I attended the AAMFT Long Beach Conference where their president Mike Bowers made a pronouncement at a conference forum of about 500 people that Mary Riemersma of CAMFT informed the California legislature that all therapists will hold the same license in the near future! I became alarmed. [...] I knew Mary. This could not have been accurate. I called Mary and she quickly informed me of this misinformation."
- Letter to the Editor, CAMFT's The Therapist magazine, Jan/Feb 2011, p. 5

Fact check: "CAMFT states, “At some time in the future, we project that there will only be one masters level profession in California, with individuals specializing within that license. Thus, those who wish to specialize in systems work will do so; those who wish to specialize in art therapy will do so, etc. The current system with a variety of acronyms is confusing for consumers who just want to be helped and do not perceive greater value from one professional compared to the next.”"
- California Senate Committee Analysis of AB1486, July 2007
- Same text appears in a CAMFT email to members, May 24, 2007

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On correcting false information, Part II

My request for correction: "Michael Bowers [is] AAMFT’s Executive Director, not its president [...] It is true that Riemersma’s letter refers to “some time in the future,” and not the “near future” as the letter writer wrote – but this minor difference is an error on the part of the letter writer, not Bowers. Bowers quoted, in his speech and in his presentation slides, the exact text the legislative report quoted."
- My Letter to the Editor again requesting CAMFT correct provable errors of fact

CAMFT response: "Your request to print the proposed correction was denied."
- CAMFT response email

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"Marriage and family therapists treat and communicate with and about colleagues in a respectful manner and with courtesy, fairness, and good faith, and cooperate with colleagues in order to promote the welfare and best interests of patients."
- CAMFT Code of Ethics, principle 5

How should religious therapists handle gay and lesbian clients?

2011-04-08T09:49:00.000-07:00

Counselors and therapists with strong religious beliefs sometimes refuse to treat gay and lesbian clients. Some even refuse to offer referrals. Can they do that?

So-called "conscience clauses" are common in health care. They allow professionals to refuse to provide a service within their scope when that service would conflict with the professional's moral or religious values. In reproductive health, for example, this allows gynecologists to refuse to perform abortions, and allows pharmacists to refuse to distribute birth control, if they find these objectionable.

Such provisions are controversial. The Obama administration has moved to (mostly) end them in federally-funded facilities, and there have been several instances where patients have been harmed -- and then filed lawsuits -- over treatment refusals based on conscience clauses.

The debate is now coming to mental health, as a result of religious therapists and students taking a stand against treating gay and lesbian clients. These cases point to an interesting contradiction in professional ethical codes:

Mental health professionals do not discriminate based on sexual orientation.
Mental health professionals do not treat clients outside of their scope of competence.

Though the specific wording varies, versions of those statements can be found in the ethical codes of every major mental health association. When a religious therapist, whose beliefs suggest that homosexuality is immoral[*], is asked to treat a gay or lesbian client (or couple), what should the therapist do?

Offering treatment would abide by the non-discrimination sections of professional ethical codes, but could lead to ineffective -- or even harmful -- treatment. Religious therapists who, perhaps by their own choosing, lack the training and experience to work effectively with gay and lesbian clients then should not ethically be treating those clients. On the other hand, refusing to treat a client based on the client's sexual orientation seems to be quite clearly discriminatory.

On issues like this where different parts of a code of ethics conflict, the ethical codes generally do not indicate which standards should take precedence over others. (They also do not allow exceptions based on the therapist's religious beliefs.) The NASW Code even includes a clear statement that it does not prescribe such an ethical hierarchy, as ethical decision-making is centered around process more than outcome. So no one really knows whether it is ethical for a therapist to refuse to treat clients in same-sex relationships.

Again, allowing a health care provider to refuse to treat clients based on the provider's religious beliefs is common in other fields (Pharmacy | Medicine), but it comes with an important caveat: The provider usually must give the patient a referral to another provider who would offer the treatment in question. In theory, that should resolve the issue; patients get the services they need while providers maintain their religious convictions. In practice, it only works if that other provider is close at hand. Patients refused services based on religious "conscience clauses" in rural areas, as well as those needing to be treated immediately for the treatment to be effective, are left without options when their provider refuses to treat them for religious reasons -- which is precisely why many states put exceptions in their "conscience referral" legislation or simply do not allow such referrals.

Some states already have "conscience clause" laws on the books that do not require any referral at all, which has drawn protest from professional associations who worry that they allow a health care provider's religious beliefs to "run roughshod over the profession’s code of ethics." In the Lincoln (Nebraska) Journal-Star, Rev. Christopher Kubat presented the case that religious therapists should be able to turn away same-sex couples without offering referrals:

Since the Catholic Church teaches that sexual relations are meant for one man and one woman in the context of marriage, if a same-sex couple requests therapy to support, validate or enhance their sexual relationship or something akin to marital therapy, it would be inappropriate to provide that specific, narrow service or make a referral for it, as referring for something considered inappropriate or immoral would itself be inappropriate and immoral because of the element of cooperation.

That strikes me as blatantly discriminatory and harmful to those in need of treatment. It also is theologically consistent.

This is the debate I wish had taken place in CAMFT's rightly-maligned (and eventually disowned) same-sex-marriage issue of The Therapist. I think there is a legitimate concern on both sides. Religious therapists have an ethical obligation not to refuse treatment based on a client's sexual orientation. But how can that treatment possibly in the client's best interests when the therapist's religion precludes them from in any way supporting the client's romantic relationship? It seems unlikely. Is there a workable middle ground?

Proposed legislation in California would attempt to at least partially resolve this issue by ensuring all mental health professionals receive training in working with LGBT populations. That may be helpful when it comes to establishing competence, but likely will not change anyone's religious beliefs.

I do not pretend to have the answer here, though I am optimistic such an answer exists. I wish all clients, regardless of sexuality, could receive competent and accepting treatment anywhere they seek it. I also do not want any of the talented religious therapists I know to feel like they need to betray their religious beliefs to work as mental health professionals. I just wish there were a place for honest, genuine, respectful debate on this issue that could land on some ethics code language on which both sides could agree. Is there a place for that?

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* - For clarity's sake, of course not all religious therapists believe that homosexuality is immoral, or would refuse to treat gay or lesbian clients. I personally know many strongly religious therapists who see no conflict at all in offering their professional services to clients regardless of sexual orientation.

Study: Marriage stays satisfying over time for many more than previously thought

2011-03-24T09:08:00.000-07:00

Newlywed couples, once thought to consistently experience a quick drop in satisfaction, actually often remain just as happy (or close to it) over time, according to a recent study. For couples who do get worse, the reasons can be evident early on. The study's author comments.

According to a study published late last year in Family Process, the rapid decline in marital satisfaction following a couple's wedding -- generally thought to be quite normal -- is actually something many couples manage to avoid. The "average" couple experiences a drop because for some couples, satisfaction declines precipitously. But many couples, including the most satisfied, actually remain fairly stable in their marital happiness.

Justin Lavner and Thomas Bradbury at UCLA monitored the progression of marital satisfaction over time among 232 couples, starting soon after the couples were married. They found that couples' progressions in happiness clustered into five different groups. For the three groups who started out the most satisfied, they tended to stay at about the same level (or decline only minimally) in the four years after their wedding day. For the two groups who started married life less satisfied, things tended to get significantly worse with time -- dragging down the population average. As might be expected, among those five groups, divorce rates varied significantly, with the groups whose satisfaction declined over time far more likely to split up.

I asked Lavner a number of questions via email about the study and its implications. The following has been edited for length and clarity. My questions are in bold, and Lavner's responses are in plain text.

BC: How would you describe your findings in plain language, and what surprised you the most?

JL: We set out to examine one of the most often-cited "facts" about marriage -- that satisfaction declines as marriage goes on. We wondered whether this average pattern obscured different patterns that couples experience, and if so, what factors characterized people who had different patterns and how these patterns related to later divorce rates.

We found that although the average pattern is indeed one of declining satisfaction, there are a few different patterns that better characterize newlyweds' marriages over the first four years, including very high, stable trajectories, as well as marriages that start off low in satisfaction and experience large declines very quickly.

Spouses with negative patterns could be distinguished by a range of factors as early as six months into marriage. These included their personality characteristics, how they interacted with their partners during a 10-minute problem-solving discussion, how much aggression they reported, and how much stress they had in their lives. Importantly, these early patterns related to ten-year divorce rates: couples with the worst trajectories had rates of divorce that were more than four times as high as those couples with the best trajectories!

I think the finding that surprised me the most was how early these differences emerged. All of the factors that distinguished between patterns were found at six months into marriage, and some couples were already dissatisfied by then. To me, this suggests that there is a lot more variability in couples early in their relationships than we had previously thought.

BC: I was amazed at the wide disparity in divorce rates for couples based on their marital satisfaction trajectories. How do you think this data can be used to inform and improve treatment for couples at risk of divorce?

JL: We often hear that satisfaction declines as marriage goes on. While that may be true on average, what's really powerful about this data is that they highlight how couples vary widely in the likelihood their relationships will deteriorate, and also give us a better idea of what types of characteristics make couples more likely to experience negative marital trajectories. Using this kind of data, we can be more targeted in our relationship education interventions and direct services toward those couples who need them most.

BC: One of your key findings is that for both husbands and wives, Personality, Stress, Aggression, and Positive Affect distinguished trajectory groups. What does this suggest for identification and treatment of at-risk couples? Do we need multiple forms of therapy geared toward couples with different traits?

JL: These findings indicate that those couples with the greatest distress (and at highest risk of divorce) are characterized by a full range of negative personality traits, experience more stress, report more aggression, and demonstrate lower levels of positive affect. This suggests that focusing on any one factor in treatment will not be sufficient: for example, we cannot focus on negative communication without recognizing how couples' personalities and stressful environments will limit the benefits they can achieve from communication training.

I see this not as evidence that we need multiple forms of therapy geared toward couples with different traits, but more that our interventions need to continue recognizing and addressing the multiple factors that affect couples' lives. My guess is that it is likely to be quite difficult to fully "match" traits with specific forms of therapy to increase success when there are multiple factors at play.

BC: You mention that the data holds some promise for early identification of at-risk couples, but temper this pretty heavily, saying that "it is nonetheless discouraging because it suggests that the task of strengthening these relationships must address a wide range of possible causes for the distress, some of which may be difficult to modify." Could you expand on this?

JL: Not only are the couples who go on to experience distress those with multiple risk factors, but some of these risk factors are likely to be quite stable, particularly their personalities and the stress they encounter. We also identify this risk very early in the relationship, which means that by the time couples present for therapy (which they are notoriously slow to do), these distressing circumstances have likely plagued them for several years.

That said, I'm still optimistic about therapy possibly changing these trajectories and ultimately reducing divorce risk for these couples, particularly if intervention occurs early and addresses multiple factors of couples' lives (as integrative behavioral couple therapy and enhanced models of cognitive behavior therapy now do, among others).

BC: You briefly talk about public policy, suggesting that broad-based marriage promotion programs are not likely to be as successful as programs targeting "the challenging circumstances and chronic stresses likely to impede relationship maintenance." In your ideal world, what would a program designed to reduce divorce look like?

JL: Ideally relationship education programs need to do more to address the complete gestalt of couples' circumstances -- their particular ways of interacting, their personal histories, and how the contexts they live and work in affect their relationships. How this would play out is still an open question, but could include modules such as personality characteristics and emotion regulation strategies, or work stress and how that affects home life, along with stress management techniques. Special attention needs to be given to recruiting and retaining high-risk couples, as this presents the best opportunity to prevent distress and divorce.

I would also like to see more attention given to factors that can promote relationship stability. These findings indicate that many couples have stable levels of satisfaction over time, so how can we help them maintain and even enhance their relationships? For example, Art Aron and his colleagues (Aron, Normon, Aron, McKenna, & Heyman, 2000) have suggested that participating in novel activities can enhance couples' relationship quality. Our programs must do more to promote relationship functioning, in addition to helping prevent deterioration in relationships.

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Comments are welcome below. In addition, you can email me at ben[at]bencaldwell.com, or help prevent deterioration in my Twitter feed.

To ease stress, and maybe save your marriage, try doing nothing

2011-03-21T11:21:00.000-07:00

When it comes to making a healthier self and a happier family, doing nothing may be the next big thing.

One of the hardest things for many of us (myself included) to fathom when we dedicate our careers to solving problems is that sometimes the best solution is no solution at all -- just do nothing. Refraining from action can be just as vital a problem-solving strategy as taking action.

Michele Weiner-Davis, the author of Divorce Busting, offers a touching blog entry about how doing nothing helped her own marriage. And there's the website that challenges you to do nothing for two minutes, which is harder than it sounds if you're used to moving at a fast pace.

Best of all: Doing nothing can be surprisingly effective.

"Taking a moment to do nothing can be very centering and calming. It allows you to slow the entire experience down and get back to a place of rational thought," says my good friend and Caldwell-Clark cofounder Aimee Zakrewski Clark, who also runs the No Stress Foundation (full disclosure: I'm on the Board of Directors at No Stress). Indeed, doing nothing can be a surprisingly useful treatment for depression, which fairly quickly improves on its own in as many as 1 in 5 untreated cases. (Naturally, if you're experiencing depression, talk it over with a doctor or mental health professional -- just keep "no treatment" on the table as an option.) And doing nothing can improve family life; the tendency for kids to be over-scheduled has been widely covered. The impact of that hyperscheduling may actually be good for kids, but at the same time, studies routinely show that families do better when they simply spend time together... even if they aren't actually doing anything in that time.

How does one go from doing a lot to doing nothing, even if for just a few minutes a day?

"Commit to one 5-minute practice per day that invokes the nothingness. You can do a simple exercise I call Choosing Your Thoughts, which engages the breath and mind to help you do just that. As you inhale and exhale through your nose, say to yourself, 'I am aware that I'm doing nothing,'" says Clark. "You can even add a smile, which will help you to enjoy the exercise."

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Adding a smile will help us both enjoy your emails to me at ben[at]bencaldwell.com, your posted comments, or your messages to my Twitter feed.

Call for Change group offers non-rebuttal rebuttal

2011-03-16T16:46:00.000-07:00

MFT Call for Change group responds to my previous post, where I highlighted several of their erroneous statements about California.

The group calling themselves "MFTs Call for Change" (CFC) has posted a lengthy rebuttal to my earlier post criticizing CFC misstatements about California, specifically in areas related to the LPCC license and its development here.

Notably, they rarely, if ever, challenge my statements of fact. They claim that my post included "misinformation," but their arguments are more often of the moving-the-target ("yes, but") variety than they are factual disagreement. And they add at least one to the list of factual errors of their own.

CFC criticizes my statement that "When CAMFT was negotiating changes to various versions of the LPCC bill, they sought to make MFTs and LPCCs as indistinguishable as possible." They would prefer I label this as my own belief, or an opinion of AAMFT-CA. But there's no need. I saw, firsthand, CAMFT's opposition to language supporting distinctiveness of professions during the negotiation process. Remember, CAMFT wanted grandparenting to be automatic for licensed MFTs based just on coursework (this version of the bill allowed exactly that), and indeed, CAMFT has continued to argue there are no meaningful differences in practice between the MFT and LPCC professions (as CAMFT themselves said, they believe "LMFTs and LCSWs may do in practice everything LPCCs may do") -- which would make the licenses effectively indistinguishable. That's not my belief, that's an argument CAMFT itself is continuing to make and act upon.
Along similar lines, CFC calls my discussion of CAMFT's lawsuit against the BBS "patently irresponsible" because... well, I can't tell why, exactly. I'm not even sure which part they're taking issue with. CAMFT sued the BBS to try to make the "gap exam" for MFT grandparenting go away, based on their belief that the practices of the professions are indistinguishable. They have very clearly said so. That the lawsuit attempted to use technical means (like the BBS's failure to consult with a state agency on exams, the one point of three in the lawsuit on which CAMFT won) to reach their desired ends (no gap exam) does not change those desired ends or the publicly-stated rationale behind them.
AAMFT-CA and AAMFT have not been "against the LPCC bill since its inception," as CFC newly and falsely claims. Primary sources here tell the tale. California counselor legislation was first introduced in February 2005. In November 2005, nine months later, I first spoke to a legislative committee about AAMFT-CA's concerns with bill language. Even then, AAMFT-CA took no formal position, as we understood the bill would be further amended. AAMFT-CA only formally opposed LPCC legislation in 2007 (this legislative committee analysis is the first mention of AAMFT-CA opposition), after it became clear that the legislation was moving in a direction that would hurt the MFT profession. Furthermore, in 2009, once we worked out the compromise language that became the LPCC law, AAMFT-CA's opposition was removed [page 2], helping the bill pass. The larger AAMFT never took any formal position at all on the bill.
In discussing Kim Madsen, the BBS Executive Director, the CFC rebuttal suggests that in my post, "The reader has been lead [sic] to believe Ms. Madsen would be less than forthcoming" when discussing licensure issues. Nonsense. Ms. Madsen has been, in my experience, extremely professional, highly ethical, and very forthcoming, even when we have disagreed on policy. In my earlier post, what I suggested was that CFC, not Ms. Madsen, was being less than forthcoming by leaving out important details. This should have been evident in my preface "I suspect what Ms. Madsen said was..." Given my experiences with each of them, I trust her to be complete and forthcoming much more than I presently trust CFC to do so.

As I said previously, the CFC group seems to be well-meaning. I just don't understand their dogged pursuit of this line of criticism. It is not supported by facts, and makes CFC look more interested in finding fault with AAMFT than actually supporting or developing the profession.

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If I did make any errors of fact -- there or here -- I would like to correct them. Email me at ben[at]bencaldwell.com, post a comment, or call for a change to my Twitter feed.

Study (questionably) says delusion key to happy marriage

2011-03-07T18:19:00.000-08:00

Are the happiest couples delusional? After reading the methodology of a new study making that claim, I come to a very different conclusion.

Okay, congratulations, Boston.com, you'll get your fair share of clicks when you post a story under the headline "Research indicates that delusion could be the secret to a happy marriage."

But the study on which that article is based supports no such claim, since the study did not look at "delusion" at all -- either in the formal diagnostic sense or the pithy separation-from-facts sense.

Here's how Boston.com (online home of The Boston Globe) summarized the study itself:

University of Buffalo researchers recruited 222 couples heading in to apply for marriage licenses to fill out surveys on themselves, their partner, and their marriage every six months for three years. They then compared the self-ratings of respondents in terms of intelligence, creativity, athletic skills, etc., with how their spouse rated their attributes. Those who inflated their partner’s assets also reported being more happily married.

Do you see anything there about delusion? Me neither. I see a study comparing each spouse's view of self with how their partner views them. Sure, when those perspectives disagree, you could say the happier spouses are "inflating their partner's assets." Or, you could say that the happier spouses have partners who deflate their own assets.

How someone's spouse views them is only "delusional" if their view of self is perfectly accurate. If, on the other hand, it is the spouse's view that is the one that's perfectly accurate, and couples are deflating their own assets, couldn't we just as well say that happy couples have delusionally poor self-esteem? That's an entirely reasonable conclusion based on the data from this study.

We might come at least a little closer to some kind of meaningful conclusion if the researchers had attempted to objectively assess "intelligence, creativity, athletic skills, etc." By all appearances, they did not, so for all we know, everybody in the study could be delusional. Or more likely, nobody is.

Occam's Razor applies here: let's go with the simplest and most logical explanation. Couples do best when they present themselves with humility, and highlight the positive traits in their spouses. There's nothing delusional about that.

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Perhaps I'm delusional -- let me know in comments or via email to ben[at]bencaldwell.com. Follow my usually-well-connected-with-reality (but no guarantees!) Twitter feed.

Call for Change group erroneously calls California licensure threat "unsubstantiated rumor"

2011-03-04T07:12:00.000-08:00

A group of well-meaning MFTs has been trying to make AAMFT more transparent and accountable. But their latest report about the LPCC license in California, which claims to have found deception by AAMFT, gets the important facts wrong.

* See updates below.

If you're a member of AAMFT or have been connected in any way with the "Call for Change," you may have received an email with an unsettling headline:

Unsubstantiated Rumor Influences AAMFT's Strategic Plan

The email goes on to say that this "unsubstantiated rumor" was the notion that there was a threat to MFT licensure in California connected to the development of the state's Professional Clinical Counselor (LPCC) license. You can read the CFC's complete report online: CA LPC Deception Revealed.

Because the threat posed by LPCC licensure was all "unsubstantiated rumor," the CFC logic goes, perhaps someone at AAMFT knowingly ginned it up for political reasons:

What could be the motives behind generating such rumors, fear, and speculation within our membership in relation to a document and process as significant as a long range Strategic Plan? Since the truth of this matter was already known by AAMFT leadership, could the reason be political?

For anyone unfamiliar, the CFC group is made up largely of well-meaning MFTs who want a more open, accountable professional association. That's a laudable goal, and they have pushed AAMFT into making some much-needed changes, especially around organizational transparency. There is surely more work to be done on that front, and for that reason, a subgroup like CFC can sometimes ultimately be a positive thing for the larger association they criticize.

In this case, though, CFC gets the important facts wrong, and loses a great deal of its own credibility in the process. It starts by reporting that Kim Madsen, the California Board of Behavioral Sciences Executive Director, told them "there had been no current or past discussions regarding replacing the LMFT license in California with the LPC license" (I'm quoting the CFC's paraphrase of Ms. Madsen). I of course was not in on this phone call, but I suspect what Ms. Madsen said was that no such discussion took place at the BBS. And, with that kind-of-important detail, that's true -- the BBS never had a public meeting or vote where replacing the MFT license was discussed or voted on.

For the CFC to extrapolate that to the notion that no one in California ever discussed eliminating the MFT license, however, is a rather significant error. CAMFT (which is not affiliated with AAMFT or its California Division) specifically discussed replacing the MFT license. You can see it in page 14 of this California legislative committee report, and the same text was in an email to members that CAMFT sent in May 2007 (emphasis mine):

CAMFT states, "At some time in the future, we project that there will only be one masters level profession in California, with individuals specializing within that license. Thus, those who wish to specialize in systems work will do so; those who wish to specialize in art therapy will do so, etc. The current system with a variety of acronyms is confusing for consumers who just want to be helped and do not perceive greater value from one professional compared to the next."

When CAMFT was negotiating changes to various versions of the LPCC bill, they sought to make MFTs and LPCCs as indistinguishable as possible. And without distinctiveness between professions, it becomes much harder to argue that distinct licensure should be maintained. Sure enough, the following language was inserted into a version of the 2008 LPCC bill (which ultimately failed; again, emphasis mine):

The Department of Consumer Affairs and the Board of Behavioral Sciences shall collaboratively evaluate the licensing requirements and scope of practice for licensed professional counselors, licensed clinical social workers, licensed educational psychologists, and marriage and family therapists. The evaluation shall include a recommendation on whether or not these licensed professions should become a general license category, and if such a recommendation is made, how it is proposed to occur.

CAMFT projected a one-license future, and that proposal found its way into proposed legislation. These are facts on the public record. They are indisputable. That legislation may have become law had AAMFT-CA and the California Psychological Association not worked diligently in opposition. For CFC to dismiss the threat to California MFT licensure as "unsubstantiated rumor" is clearly and demonstrably incorrect.

CFC goes on to question how CAMFT could possibly have any influence over license transitions, since it is the BBS and not any professional association that enforces licensure standards. This is shockingly naive. CAMFT does a tremendous amount of work (often very good and beneficial) on state legislation, and the licensure standards the BBS exists to enforce are written in state law; the BBS has no right or authority to refuse to enforce a law once it takes effect. Almost every major piece of state legislation that has impacted California MFTs in a generation has had CAMFT's fingerprints on it. If CAMFT wanted MFTs to become LPCs, they wouldn't politely ask the BBS to make it happen. They would seek to change the law, and they have the resources to do so. As you can see above, a change in the law is precisely what could have happened.

Even after the final version of the LPCC law passed in California, CAMFT has continued to work hard at making MFTs and LPCCs seem indistinguishable. When even the relatively minor barrier of a "gap exam" for MFTs seeking grandparenting into LPCC licensure arose, CAMFT not only fought it, they sued the BBS -- a suit that could have, among other things, led to a court ruling that the professions are not distinct.

Thankfully, CAMFT largely lost that suit. There will be a gap exam, and the BBS is supporting distinctiveness between MFTs and LPCCs in other ways. But for CFC to suggest that there never was a threat to the MFT license in California -- or indeed, to even suggest that threat has fully abated now -- is simply out of line with reality.

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Full disclosure: I have served as a consultant to AAMFT in the past (not currently), and still volunteer regularly for the California Division, though I hold no official role there. I was part of the AAMFT-CA negotiating team on California LPCC legislation. I'm a former CAMFT member; their lawsuit against the BBS led me out the door.

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Updated 3-16-2011: The Call for Change folks have posted a rebuttal to my post here. See: CFC rebuttal // My response

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The image above is the semaphore sign for "error." Think I'm out of line with reality? Post a comment below or email ben[at]bencaldwell.com. Follow my Twitter feed.

In "Gap Exam" and supervision rulings, California licensing board says MFTs and LPCCs are different

2011-02-23T15:36:00.000-08:00

In a unanimous vote, the California Board of Behavioral Sciences (BBS) today determined that a Gap Exam will be necessary for marriage and family therapists (MFTs) seeking licensure as professional clinical counselors (LPCCs). A separate ruling on supervision has similar themes.

The "Gap Exam" for currently-licensed MFTs seeking to grandparent into LPCC licensure will be shorter than regular licensing exams, and will focus on the differences in practice between MFT and LPCC.

In a separate vote, the BBS also agreed to move forward with a legislative proposal that would require LPCCs to complete additional coursework and experience in couple and family work in order to supervise MFT interns and trainees.

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Gap Exam

Today's vote was the fourth the Board has taken on the Gap Exam issue, which has become controversial because of its broader implications about the distinctiveness of the professions. (For some of the history, see "CAMFT sues California licensing board" and "Ruling mixed in CAMFT-BBS gap exam lawsuit." Full disclosure: I resigned CAMFT membership in response to their actions on this issue.) Earlier votes had been set aside for a variety of reasons; the most recent prior vote was set aside after CAMFT sued the BBS, and won on their argument that the BBS had not first consulted with the state's Office of Professional Examination Services, as required in the law. The court ordered the BBS to set aside its prior vote and do the required consultation.

In that required consultation, OPES said they believed a Gap Exam was indeed necessary (last pages of PDF), and the BBS today voted to move forward with the Gap Exam. The exam development process will start immediately. Today's hopefully-final vote supports the notion that while mental health professions have much in common, there are still meaningful differences between the practices of the specific professions.

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Supervision

Similar themes arose in discussion on supervision in mental health care. In current law, LPCCs must complete additional coursework and experience to be able to legally assess or treat couples and families. The question at hand was whether LPCCs who had not met those requirements should be able to supervise MFT trainees and interns who would be providing direct services to couples and families.

I argued the AAMFT-CA perspective, that one should not be legally able to supervise an activity that is outside of one's own scope of practice. The BBS voted in agreement. Unlike the exam ruling, however, this vote was by no means a final determination. It merely moves forward proposed legislation that would allow LPCCs to supervise MFTs only if the supervisor has completed those additional requirements. The proposal still must go through the legislature and be signed by the Governor to become effective. CAMFT indicated they will oppose that provision during the legislative process. If CAMFT moves to simply kill the proposal, and is successful in doing so, LPCCs will be left with what is in current law -- which prevents them from supervising MFT interns or trainees at all.

California's complex plan to save mental health funding by slashing it

2011-02-10T15:41:00.000-08:00

To balance the state's budget, Governor Jerry Brown has proposed raiding a state fund set aside to transform public mental health care. In return, he's promising long-term fixes to the structural underfunding of public mental health. Is it a fair trade?

California Governor Jerry Brown has inhereted a budget deficit estimated at $25 billion, which everyone agrees will require significant changes in state services. One fix the Governor has proposed is raiding Mental Health Services Act (MHSA, originally known as Proposition 63) funds, an idea voters rejected as a budget fix in 2009.

This time around, Brown is proposing a novel compromise: let the state raid the MHSA fund on a one-time basis, and in return mental health services will get a longer-term, structural fix to chronic underfunding. It's an intriguing proposal.

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Thanks to a the MHSA, a voter-approved tax on millionaires*, California currently has about $2 billion set aside specifically for the improvement of its public mental health system. This money is meant to be used to provide new and expanded services, train public mental health workers in current research-supported approaches, and generally transform the system to one that is modern, client-centered, and accountable. (By law, the money specifically cannot be used to pay for existing services, which are chronically underfunded.) Many marriage and family therapists are employed in public mental health in California, often in clinics funded by Medi-Cal.

Of course, in a budget crisis, it is easy to see how elected officials could view $2 billion sitting in the bank as a budget-solution-in-waiting. Governor Schwarzenegger proposed raiding this fund in 2009, asking voters to shift $460 million from MHSA funds into the state's General Fund. The proposal was defeated by a landslide.

In contrast to the failed 2009 proposal, Governor Brown proposes a scheme that -- at least in theory -- could help the state budget in the short term and preserve mental health funding in the long term. It includes several moving parts:

Shifting $861 million from the MHSA reserve account to the General Fund. The shift would pay for current mental health services for the 2011-2012 fiscal year. Net impact: Bad. But could be worse. Obviously, this is a setback for planned MHSA-funded new and expanded programs, but the money would still be used to pay for mental health services, and would be a one-time shift.

Shifting responsibility for three mental health programs from the state to counties. The programs include Early and Periodic Screening, Diagnosis and Treatment (EPSDT); Medi-Cal mental health managed care; and special education mental health services (known to professionals as AB3632). Net impact: Unclear. "Local control" is sometimes better in concept than in reality; state administration ensures careful auditing to ensure money is being spent wisely, and consistency in program standards. County control of these services may lead to some cost savings, but those are often overstated.

Changing how the state funds mental health. Starting in the 2012-13 fiscal year, mental health services would be given an additional dedicated portion of state sales tax and vehicle license revenues. These are projected to grow at approximately a 6% annual rate. Net impact: Good. Currently, mental health programs are funded through a mechanism that grows at about 2% a year, according to the California Council of Community Mental Health Agencies -- lower than normal inflation, and certainly not enough to account for any growth in patient population. This is a prime example of structural underfunding, which leads to ever-increasing caseloads and access-to-care problems.

All of this adds up to a proposal that has public mental health leaders more cautious than optimistic. The California Mental Health Directors Association asks a long list of good questions about the proposal, most of which are presently unanswered.

But the fact that a proposed $861 million raiding of public mental health funds is not being met with noisy protests from the agencies that rely on those funds is telling. It suggests that the proposal may have merit.

In the state's current budget environment, we know lots of cuts will need to be made. Some of those cuts are likely to impact public mental health workers, including marriage and family therapists. Weathering the storm with a minimal amount of damage to public mental health, and even a potential long-term improvement to how it is funded, could be a very good outcome. Maybe.

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* Background on MHSA: As Governor Brown notes in his budget proposal,

To provide additional resources for county mental health services, voters passed the Mental Health Services Act (Proposition 63) in 2004. The intent of Proposition 63 was to reduce the long‑term adverse impact of untreated mental illness by developing services or expanding existing services at the local level. To fund these resources, Proposition 63 imposed a one‑percent surcharge on personal income over $1 million.

That tax brought in $2 billion more than expected in its first four years. (The budget proposal fails to mention that since then, the MHSA has brought in less than expected due to the worsening economy.) Counties have engaged in a long-term planning process for how they would use MHSA money to transform their mental health systems; by law, MHSA money was not to be used as simply a replacement funding stream for existing services. So while the MHSA currently has about $2 billion in reserves, counties have been planning for -- indeed, counting on -- that money to be available.

California CE providers routinely violate ad regulations

2011-02-07T14:15:00.000-08:00

A review of 15 advertisements for continuing education events for California MFTs and LCSWs finds that all of them violate state regulations by leaving out required information. If no one is complaining, do we need the regulations?

Continuing education providers in California are expected to offer some basic information about themselves and their events when advertising, just as licensed marriage and family therapists are expected to have our licensure information attached to any advertising we do. Ideally, these disclosure requirements prevent less-than-reputable folks from putting on less-than-worthwhile CE events to swindle therapists out of money.

But no one is following the requirements.

And that's a literal "no one," at least in our sample. Not one advertisement followed the letter of the law.

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We (my research assistant and I) reviewed ads from every issue in volume 21 (2009) of The Therapist magazine, published by the California Association of Marriage and Family Therapists every two months. We want to emphasize that CAMFT is not in any way responsible for policing outside ads; it is the CE providers who are solely responsible for their own advertising content. We found a total of 15 unique ads, many of which appeared in multiple issues; we did not count duplicates in our calculations.

Section 1887.9 of the California Code of Regulations (it can be viewed in the BBS laws & regulations booklet, page 142 by the on-page numbering, page 149 of the PDF) requires all CE providers to:

ensure that information publicizing a continuing education course is accurate and includes the following:
(a) the provider's name;
(b) the provider number, if a board-approved provider;
(c) the statement "Course meets the qualifications for _______ hours of continuing education credit for MFTs and/or LCSWs as required by the California Board of Behavioral Sciences";
(d) the provider's policy on refunds in cases of non-attendance by the registrant; and
(e) a clear, concise description of the course content and objectives.

Providers seem to be simply ignoring this. We found a total of 15 unique ads for in-person CE events. We ignored ads for online or mail-in courses; they usually were advertising the provider, and not a specific course, and thus they are probably not subject to the above requirements.

We found that among the 15 ads we reviewed, providers routinely ignored all of the required information except the provider's name:

Item	Ads containing	Ads missing	% of ads containing
1. Provider name	14	1	93%
2. Provider number	7	8	47%
3. "Meets qualifications" statement	0	15	0%
4. Refund policy	2	13	13%
5. Course description	8	7	53%

Another way to look at this is to see what proportion of ads had 2, 3, 4, or all 5 of the required pieces of information:

Items present	Ads	% of all ads
One or more	15	100%
Two or more	11	73%
Three or more	3	20%
Four or more	2	13%
All five	0	0%

The requirements exist to ensure that when licensees hand over their money to CE providers, the licensee knows what they are signing up for and those hours will legitimately count toward the licensee's continuing education requirement. But the BBS does not enforce those requirements unless they receive a complaint, and such complaints are rare: in a 7-month span reported here, the BBS received just three complaints against continuing education providers. (And those were not likely to have been about advertising, judging by prior complaint data.) For comparison, there are more than 2,000 approved CE providers in the state.

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The relative rarity with which the requirements are followed, combined with the relative lack of complaints against continuing education providers, raises an important question: Are these regulations really helping anybody?

Certainly the BBS has better things to do with its enforcement unit than go after such minor omissions. Maybe it would be better to take the requirements off the books entirely.

Or, maybe the current landscape is just fine. After all, it allows licensees who feel they have been duped by unscrupulous CE providers to complain, and gives the BBS leverage to act against the provider who failed to advertise appropriately. It's the CE-advertising equivalent of jaywalking: we all want the cops to focus their work on more important things, and it's really only a problem when somebody gets hurt.

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If you're wondering, the flowers in the picture are forget-me-nots. Seemed appropriate.

Wyoming bill would require counseling before marriage or divorce

2011-02-04T08:47:00.000-08:00

With some exceptions, three hours of premarital or pre-divorce counseling would be required. For divorcing couples, it’s good policy, even though it is unlikely to reduce divorce rates. It is much harder to justify the premarital requirement, on either a clinical or policy level.

A bill introduced in this year's session of the Wyoming state legislature, HB0065, would require couples to attend three hours of premarital counseling before obtaining a marriage license, and three hours of marriage counseling before obtaining a divorce.

While there is little data to suggest that any three-hour process for couples already planning to split up will make much of a dent in the state's divorce rate, requiring divorce counseling is a good idea for other reasons. Divorce education reduces conflict in the divorce process, particularly where custody is concerned (see this summary of several studies on divorce education for parents), and saves the divorcing couple as well as the public a significant amount of money in the process. Three hours is not an unduly burdensome amount, and the a judge can waive the requirement if the court finds there is "clear and convincing evidence that marital counseling will not lead to a reconciliation of the parties" -- an important consideration for victims of relationship violence. Several states have adopted such programs, often similar to one called "Children in the Middle," with good results.

The premarital counseling requirement is harder to support, either on a policy or scientific level -- and this is coming from a guy who specializes in couples work (San Diego marriage counseling) and loves premarital counseling.

There is ample evidence that these relationship education programs improve communication, but it is unclear whether premarital education actually improves relationship satisfaction or stability, and there is virtually no evidence to suggest they actually have a long-term impact on divorce. (That's primarily due to a lack of data, not studies showing failure.) A recent, thorough review in the journal Family Relations described current research on the very basic question of whether these programs work as "not as settled as program developers and practitioners might assume or like it to be." There are at least three large-scale, federally-funded demonstration projects of premarital education (Appendix 2) underway now that should provide clearer answers.

In the meantime, these programs continue to grow because they are, in the words of one report, "popular and valued." And there is some evidence to suggest they have a greater impact on low-income families, who do suffer from higher long-term divorce rates.

But here's the catch. In the studies that have been done, as well as the large studies underway now, few have suggested that just three hours of education would be enough to even expect an impact. The federally-funded studies use programs of at least 24 hours of education. Most programs utilize at least 12 hours. Anything under eight hours was considered in the Family Relations review to be a "low-dosage" program.

This is why it's so hard to get behind the premarital requirement in the proposed Wyoming law. I could see requiring 12 hours, and I can certainly understand requiring none. But three hours? It adds a hurdle to marriage, without sufficient reason to believe it will have a lasting positive impact. And while I believe quite strongly that premarital education can be effective, I cannot support requiring an amount of it that is too low to have any likely effect. Wyoming and other states should either require enough premarital education to make a lasting difference, or none at all.

Insights from 5 1/2 years of California MFT license exam data: A defense of underperforming programs

2011-02-01T12:05:00.000-08:00

Some MFT programs' graduates perform poorly on California's MFT licensing exams. Don't assume that means the program is of poor quality; there may be good reasons.

We've seen that there are huge differences in performance on the California marriage and family therapy licensing exams based on what graduate program the test-takers attended. We've also seen that for-profit MFT programs should not be dismissed simply because they aim to make money; Argosy graduates do particularly well on the exams, while University of Phoenix graduates do not. I've said before, though, that there are lots of things to consider when choosing a graduate program in MFT, and that graduates' exam performance should only be one of many such considerations. Indeed, there are some major problems with putting too much stock in exam data.

If you are looking at graduate programs, and are concerned about your prospective MFT program's exam pass rate, here are three reasons why you may want to ignore the exam data:

Programs can and do improve. Exam data reflects students who graduated years earlier. Remember, it takes the average MFT intern in California more than four years to move from graduation to the licensing exams. That number is a bit lower for graduates of COAMFTE-accredited programs, primarily because they do more practicum hours while still in school. Nonetheless, if you are looking at MFT licensing exam data from 2009 and earlier (the link will take you to a searchable database of California programs), you will find very little information on anyone who graduated much past 2005, and nothing to tell you which programs have gotten better or worse since then. Consider the recently-COAMFTE-accredited programs at Chapman University and Hope International University. Their national accreditation should arguably make them more appealing (and thus competitive) programs for prospective students and faculty alike. That's important, and simply is not reflected in currently-available exam data.
Programs seek to give students opportunities. Consider for a moment the state's worst-performing program, according to this table that appeared in Part I of this series: Pacific Oaks College. Based on the pass-rate statistic alone, one might presume that the Pacific Oaks program is not very good. But that conclusion can't safely be made from that data. Pacific Oaks, over the past few years, has specifically sought to provide opportunities to historically underserved populations, creating cohorts specifically for African-American Family Therapy and Latino Family Therapy. (This outreach is vital: Lots of evidence suggests that the mental health workforce is not meeting the needs of minority populations, either in California or around the US.) Students in these cohorts may lack the family, economic, and social support, as well as the earlier educational opportunities, that other students often have. Pacific Oaks goes to great length to remediate these earlier deficits, and may be doing more, with less, than programs who start with more economically- and educationally-advantaged students. When financial and accreditation concerns threatened to close the Pacific Oaks in 2009, I was one of many who stood up in defense of keeping the program alive, and have no reservations about having done so.
Programs have no control over what students do after graduation. A program can really only control what happens from the time students are in the program to the time they graduate -- and even then, programs have limited control over how well their students prepare themselves. A great supervisor can help an MFT Intern/Associate make up for deficiencies in their education, and help get them ready for licensing exams. Poor supervision may leave the Intern/Associate on their own to prepare, or even offer incorrect information that ultimately harms one's chance of passing the exams. And of course, programs have no control over whether their graduates use MFT exam prep programs, although there is little evidence that these prep classes actually impact MFT exam pass rates.

Of course, before you do go dismissing a program's exam pass rate, take some steps to get reassurance that you are making that decision wisely. If you are considering attending a program whose graduates have not performed well on recent licensing exams, ask the program (1) why, (2) what they're doing about it, and (3) what evidence they have that they're getting better. If the program can't pass that test, then it's time to wonder whether you would be able to pass yours.

Ruling mixed in CAMFT-BBS "gap exam" lawsuit

2011-01-27T14:20:00.000-08:00

Court finds the BBS must consult with Office of Professional Examination Services to determine whether a "gap exam" is needed for MFTs seeking LPCC licensure.

At 11:00 this morning, the California Superior Court for Sacramento County issued a tentative ruling in the CAMFT-BBS lawsuit over MFTs who wish to be grandparented into LPCC licensure. It leaves hanging the question of whether there will actually be such an exam -- though it appears highly likely.

I've previously written about the issue here and here, the first of which offers a better review of the details.

Today's ruling is mixed, siding with the BBS on two key questions and with CAMFT on one:

The BBS was within its authority in determining that "the profession" and "the practice of the profession" mean effectively the same thing.

The BBS was within its authority (and reading the law reasonably) in determining that those seeking grandparenting into LPCC licensure must be tested on any differences between the professions.

The BBS went beyond its authority by determining that a "gap exam" was necessary without adequate consultation with the state's Office of Professional Examination Services (OPES), as required by law.

Ultimately, the court orders that the decision to require a "gap exam" be set aside until the OPES consultation has taken place (which must be within 60 days) and the BBS makes a determination based in part upon the results of that consultation. Since the BBS and its contracted consultant both previously concluded that there were meaningful differences between the professions, the court ruling on the first two questions above suggests a strong likelihood that the BBS will go forward with an exam, but it is not fully certain.

You can read the ruling in full here.

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Updated 1-30-2011: The court heard oral argument on Friday, to no effect -- it adopted what had been the tentative ruling. The BBS now has 60 days to consult with OPES and make a final determination on the need for a gap exam.

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Update 2-6-2011: CAMFT has released their spin on the Gap Exam ruling, which seems sure to mislead at least some readers. There's nothing there that's technically incorrect, but it takes a fair amount of reading to get the full picture. People who just read the headline, or even the headline and the first couple of paragraphs, will likely come away believing there will be no Gap Exam. Since CAMFT lost on the two substantive arguments that would suggest the exam is unnecessary, it still seems likely that an exam will be given.

Also updated the headline, as the court adopted its tentative ruling.

CAMFT changing therapist-referral site to "Counseling"

2010-11-15T13:39:00.000-08:00

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

2010-11-10T10:40:00.000-08:00

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:

Texting causes drinking.
Drinking causes texting.
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

2010-11-04T13:52:00.000-07:00

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 up to $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 San Diego campus, but helped launch our Sacramento and Los Angeles MFT programs, and have taught in Irvine 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

2010-11-02T09:34:00.000-07:00

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?

2010-11-01T12:40:00.000-07:00

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?

Studying for MFT licensing exams

2010-10-27T16:48:00.000-07:00

If you are soon to be taking your state's marriage and family therapist (MFT) licensing exams, congratulations! Here are five tips on how to study and prepare.

Licensing exams are a major milestone in the professional development of a marriage and family therapist (MFT). While there are differences from state to state, every state except California uses the National MFT Exam, and most states require that exams be taken at the completion of at least two years of full-time, post-masters experience in supervised practice. (California uses exclusively its own exams.) As you approach completion of the supervised experience necessary to take the exams, how can you best prepare? Here are five things that can help:

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1. Start preparing early

Your preparation for licensing exams should really be an ongoing process from the time you start your education. Keep those textbooks; they will be handy references for test preparation and throughout your career. Ask your supervisor questions about specific theories and how they are applied. Make sure you are keeping up with advances in law and professional ethics.

Test-specific preparation (specific study time, workshops, practice exams, and/or other methods you find useful) should start at least a few months before your test date. While there is no magic number guaranteed to improve exam performance, it is not unusual to hear MFTs say they spent six months or more specifically preparing for the exams. Licensing exams are anxiety-provoking enough; do not make the anxiety worse by procrastinating on your preparation to the last minute.

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2. Use your support system

Even in the best of circumstances, preparing for licensing exams can be stressful and time-consuming. Let your partner, family, and close friends know ahead of time about the exams and how you are planning to get ready for them. Not only can these social connections offer you support and understanding, they also can help keep you accountable for following through on your plans.

You should also make sure your supervisor is well aware of your approaching exam date. They may be able to offer additional specific guidance and supervision to make sure you are ready for the big day.

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3. Use test preparation companies if you wish

There are a number of companies that specifically work to prepare folks for MFT licensing. Generally, these companies will offer workshops, study guides, study materials (like charts or flash cards), and practice examinations. They usually will sell these products separately, but offer discounts when you buy multiple products in a package.

In California, AATBS, PASS, and Gerry Grossman Seminars all offer help in preparing MFTs for the state's Standard Written Exam and Written Clinical Vignette Exam.

For the National MFT Exam, prep products and services are offered by AATBS, PASS, Gerry Grossman Seminars, Licensure Exams Inc., and Family Solutions Institute. The Texas Division of AAMFT also produces an MFT Exam Preparation Manual.

The Association of Marital and Family Therapy Regulatory Boards (the organization that actually develops the National MFT Exam) will let you purchase a practice test that closely emulates the real thing. They also offer an exam handbook with information on the test and a few sample questions.

A cautionary note: I have heard the argument many times that MFT exam prep companies do not provide good value relative to their high cost. I'll address that issue in a separate post. To be sure, not everyone needs or wants the added preparation, and the companies offer nothing that is top secret; the knowledge and tools to pass the exams should already be available to you. But many MFTs say they appreciate and have benefited from what these companies offer.

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4. Plan test day strategies

Of course, all the studying and preparation in the world will not be much help if you go into the exam room and are overwhelmed with anxiety. Thankfully, you've been doing therapy for at least a couple of years now -- you know a thing or two about helping people handle their nerves! Put that knowledge to work on yourself, and use the strategies you find most effective. It was helpful for me to have a relaxed breakfast, and sit in my car for a while listening to music to keep me calm before the test. Other things people often find helpful include:

Visiting the testing facility in advance, so you know how to get there, what the building looks like, and how long the commute will likely take.
Having a checklist for your test day, to avoid forgetting anything you will need (like ID).
Arriving early, to avoid the added stress of rushing.
Deep breathing and/or focused meditation.

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5. Keep perspective

Yes, a licensing exam is a high-stakes exam. But it is still just an exam. And at least judging from California data, a majority of people who fail an exam the first time do pass eventually. So even if you do not pass the first time, it only slows you down a bit and gives you more time to study. And when you take the exam again, you will be even more familiar with the test and how it works.

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It is also always a good idea to know and make use of additional resources that may be available to you. MFT professional associations may have local groups of prelicensed members who collaborate on exam preparation activities. Also, some graduate programs provide workshops for their alumni who are getting close to taking the exams. You may have other resources at your disposal as well, so stay in touch with colleagues in your area who are about to take the exams themselves, as well as those who have recently taken the tests.

If your exam is coming up soon, good luck!!

CAMFT sues California licensing board

2010-10-22T11:31:00.000-07:00

CAMFT is suing the Board of Behavioral Sciences (BBS), demanding a ruling that the practice of marriage and family therapy has nothing unique to offer.

See updates below: The court sided with the BBS on two out of three legal questions and CAMFT on the other. The ruling required the BBS to consult with the state's Office of Professional Examination Services prior to determining whether a gap exam was necessary. OPES recommended doing the exam, and the BBS voted unanimously to do a gap exam.

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The California Association of Marriage and Family Therapists (CAMFT) followed through on an earlier threat and filed suit this week against the state's licensing board, the Board of Behavioral Sciences (BBS). CAMFT is seeking a ruling that marriage and family therapists who wish to be grandparented into licensure as Professional Clinical Counselors (LPCCs) will not need to take an exam on the differences in practice between those professions. But the issue is bigger than it may sound: Such a ruling would require the BBS to first determine that there are no differences in practice between the professions, a ruling that would have major implications for the future of professional licensing in mental health.

But let's start with where this is now. The law that brings the LPCC license into the state is quite clear (emphasis mine):

The board and the Office of Professional Examination Services shall jointly develop an examination on the differences, if any differences exist, between the following:
(A) The practice of professional clinical counseling and the practice of marriage and family therapy.
(B) The practice of professional clinical counseling and the practice of clinical social work.
- California Business & Professions Code section 4999.54(b)(1)

CAMFT argues in its suit, as it has in BBS meetings, that there may be differences between the professions, but that these do not amount to differences in practice. So they do not believe that an exam on differences between MFT and LPCC (a "gap exam") is necessary. That argument has now lost twice: The BBS ruled on July 28 that there should be a gap exam, based on the language of the law. CAMFT threatened to sue (page 6), and the BBS vacated all earlier discussion and took the issue up again on September 9. Again they ruled that there must be a test. In a suit filed on Monday, CAMFT argues that requiring a gap exam amounts to an unlawful restraint of trade for MFTs seeking LPCC licensure. They ask to have the BBS decision again vacated, and an injunction issued preventing the BBS from requiring a gap exam.

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While I am trying to present these facts as neutrally as possible, I am hardly an objective observer. I co-signed AAMFT-CA's letter to the BBS encouraging them to revisit their initial decision in May that no gap exam would be needed. And, fundamentally, I believe there are significant differences between the professions -- that's why we have distinct educational programs and are distinctly licensed. Arguing that the professions may be different but their practices -- the doing of the professions -- is the same is a giant leap of both language and logic. Indeed, as Dean Porter, head of the California Coalition for Counselor Licensure, has said, proving LPCCs' distinctiveness [currently-third item, "AMHCA lauds..."] was one of their biggest challenges in achieving licensure in California.

There is no need for a separate license if the professional group in question has nothing new or different to offer. That is why this is such a concern for me -- if CAMFT gets their way, and the BBS or a court rules that there are no differences in practice between the professions, it is an extremely short logical walk to an argument that MFTs and LPCCs (and even LCSWs) should not be separately licensed. I worry that that's the idea. CAMFT has stopped publicly advocating such a shift (they openly projected such a "one-license future" to members and to the California legislature in 2007), but they still seem to be walking down that road. Having earlier removed their opposition to LPCC licensing legislation, they appear to have taken no action when a 2008 version of the LPCC bill proposed to study eliminating the MFT license entirely (see Section 6, at the bottom of the next-to-last page; that version of the bill, thankfully, failed). This week's legal action seems to be a continuation of the "we have nothing unique to offer, so let's all combine licenses" philosophy. Why an association of marriage and family therapists would continue taking stances that appear to act against keeping the MFT license distinct is beyond my understanding.

I would love a different explanation, but cannot seem to come up with one.

The legal complaint and related documents can be downloaded here *. They are referenced by case number (34-2010-80000689).

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I know I say this over to the right, but it bears repeating: On this blog, I speak strictly for myself, and not my employers or contractors or anyone else. It also bears repeating, for those of you from outside California, that CAMFT is an independent organization with no ties to the American Association for Marriage and Family Therapy (AAMFT) or its California Division (AAMFT-CA).

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* Updated 1-11-2011: Updated link.

Updated 2-3-2011: The court has issued its ruling, which sides with the BBS on two out of three legal questions and CAMFT on the other. See this post for details: Ruling mixed on CAMFT-BBS "gap exam" lawsuit.

Updated 2-27-2011: OPES recommended doing the exam, and the BBS has voted unanimously to do a gap exam.

Insights from 5 1/2 years of California MFT license exam data: Part II

2010-10-18T10:20:00.000-07:00

In part one, we learned that there are huge differences between programs in how their graduates perform on California's MFT licensing exams. Here, we'll see how for-profit programs measure up. You may be surprised.

For-profit universities have come under scrutiny in the past few years for aggressive recruiting practices and high costs. While the overwhelming majority of marriage and family therapy graduate programs are non-profit (either public or private), here in California a few programs are in the business of education to make money.

Some of the scrutiny faced by for-profit universities revolves around whether they are so eager to bring in new students that they accept unqualified students who cannot succeed in their fields. Since MFT licensure requires an examination that every applicant takes, we have a handy, easily-measured research question:

How do graduates of for-profit MFT programs perform on state licensing exams, compared to graduates of non-profit programs?

From this list of for-profit colleges and universities, we can identify at least four for-profit MFT programs in California:

University of Phoenix - San Diego
University of Phoenix - Sacramento
Argosy University
California Southern University

These programs, as it turns out, are widely varied when it comes to their graduates' exam performance.

Table 1: Pass rate, CA Standard Written Exam, Graduates of for-profit MFT programs

Considering the better-than-average performance of Argosy graduates and the worse-than-average (but by no means abysmal) performance of Phoenix graduates, it seems that little can be safely concluded about an MFT program simply on the basis of its for-profit/non-profit status. So here are three money-centered things I would ask any program, for-profit or not, about if I were a prospective student:

A true accounting of costs. For-profit programs may be expensive, but non-profit programs can be too. Unfortunately, it is not as simple as asking "How much is the tuition?" Availability of financial aid should be a factor, particularly the question of how much aid comes in the form of loans (which need to be paid back) versus scholarships or grants (which do not). It also may be wise to ask about additional costs separate from tuition (books, fees), and whether the program will make you eligible for various stipend and loan reimbursement programs offered at the county, state, and federal levels. Students at for-profit universities appear to have particular difficulty repaying their loans.
Graduation rates. If programs (for-profit or not) are, in fact, admitting students who cannot succeed, that may not show up on licensing exam data; the students simply would never get that far. A key criticism of for-profit programs has been that they suffer high dropout rates, leaving students with additional debt but no additional job qualifications to show for it. Ask how many students actually complete the program relative to those who start.
Where your money goes. You want the bulk of your tuition money to support your learning. How much does the program spend on faculty salaries, learning technology, and other support for student learning, as opposed to administration, investments, or other costs? Naturally, some other costs are needed for any program to function. But as a general rule, the bulk of your tuition money should be going toward those things that most directly impact your educational experience.

Elsewhere on this blog I've described some other factors that may help you choose the best MFT graduate program for you. The questions here are more financial in nature. They're all worth asking about.

Ultimately, I would not dismiss any of these programs simply because of their for-profit status. Any of them may be the right fit for you. Ask questions, and make sure any decision you make on a graduate education is a well-informed one.

Should you pursue a doctorate in MFT?

2010-10-15T11:39:00.000-07:00

Have you considered pursuing a doctorate in marriage and family therapy? There are at least three good reasons why you should.

Like many programs, where I teach (Alliant) we offer both masters and doctoral degrees in marriage and family therapy. Many of our masters students spend significant time in their second year weighing out this question:

Will pursuing a doctoral degree in MFT be worth the time, energy, and money it takes to get all the way through it?

Obviously, it is a decision that needs to be made with careful consideration of individual circumstances. Not everyone will benefit the same way from getting a doctorate in MFT. And it is highly unlikely to be a good investment if you start a doctorate and do not finish it. But depending on what you want to do with your career, completing a doctoral program could be the best investment you ever make. Here are three reasons why.

You can do more with a doctoral degree than a masters. With a doctorate, you may be more likely to secure a university teaching position, either full-time or as an adjunct faculty. In clinic settings, MFTs with doctoral degrees may be more likely to be elevated to supervisory or program-director roles. For tasks that an MFT can do only with additional training, such as psychological testing (laws differ on this from state to state), doctoral programs may provide that training. Finally, depending on the specifics of your state and the type of doctorate you pursue (i.e., Psychology with an emphasis in family therapy versus simply MFT), you may be able to license as a Psychologist, which can offer a broader scope of practice.
You are likely to make significantly more money with a doctorate than with a masters degree. The gap in MFT salaries between those with masters degrees and those with doctorates in the field is growing significantly, at least in California. I've referenced this previously, but it is worth repeating:
The incomes of MFTs at the masters level have been effectively flat since 2002, rising only from $47,851 to $50,689. This increase is less than what would be expected from inflation alone. Doctoral-level MFTs, however, have seen their incomes grow significantly – including in the current economic downturn. I’ve turned CAMFT’s data since 2004 into a graphic to show the difference:
Since 2004, while masters-level MFTs have seen little to no increase in income from the profession, those with doctoral degrees have seen their annual incomes rise by almost $10,000, from $62,885 in 2004 to $72,165 in 2010. [See my cautionary notes about this data here.]
This may be because MFTs with doctorates are performing different tasks and roles, as noted above, or it may be that MFTs with doctoral degrees are getting paid more even when in the same roles as colleagues with masters degrees. Here are two reasons why the latter is at least a possibility: (1) If you license as a psychologist (see above), insurers may reimburse you at a higher rate; (2) In private practice settings, regardless of your licensure, private-pay clients may be willing to pay you more because they see "PhD" or "PsyD" or "DMFT" after your name.
Better clinical understanding. When I began my doctoral program, it was not to make more money or to work my way into a teaching position. It was because I wanted to be a better therapist. There is no doubt in my mind that my doctoral program helped me to do just that. My understanding of theory, and ability to effectively apply it in session, both improved by leaps and bounds. Even if I had sought out a career specifically in private practice, I would have served my clients far more effectively with my doctorate than I would have with a masters. And that would have been enough for me to call it a good investment.
Since then, a number of professional doors have opened to me as a result of the doctorate that would not have otherwise, and I'm thrilled that things have turned out the way they have! But even if they had not, I still would have been wise to get my PsyD.

Of course, as I said above, a doctoral degree is not for everyone. If what you want to do with your career is get into the mental health workforce, get licensed as quickly as possible, and focus on delivering effective clinical services, the clinical-skill benefits of the doctorate may or may not ultimately be worth the investment. On the other hand, if you have any interest in teaching or doing research, a doctorate will help you significantly. And if you have any other motivations to seek (or avoid) the doctorate, take them honestly into consideration. Only you can decide what is the best path for you.

Reference:
Riemersma, M. (2010). The typical California MFT: 2010 CAMFT member practice and demographic survey. The Therapist, 22(4), 28-36.

Insights from 5 1/2 years of California MFT license exam data: Part I

2010-10-06T08:09:00.000-07:00

California's 80-ish degree-granting MFT programs are hard to compare. While there are minimum curriculum standards every program must meet, each has its own personality, its own goals, and its own structure. For prospective students, it can be difficult to figure out which programs offer them the best chances of success in the field. There's really only one common yardstick that every student, from every program, ultimately gets measured on: Licensing exams.

California's Board of Behavioral Sciences routinely publishes licensing exam success rates for each program in the state, in six-month increments. The most recent data can be viewed on their web site for the Standard Written Exam and the Written Clinical Vignette Exam. However, the small sample sizes that result from using six-month intervals make meaningful comparison difficult; smaller programs are particularly prone to large swings in their graduates' exam pass rates from one six-month period to the next.

I gathered the BBS data going all the way back to 2004 to see whether bigger sample sizes might allow for some more solid conclusions -- or at least better-informed guesses -- about how MFT programs around the state compare to one another.

Before we dive in, some pretty major caveats need to be put forward. (1) My student assistants and I did the best we could to cross-check and validate the data, but we cannot guarantee that we did a perfect job. You are cordially invited to check our work (details at the end of this post). (2) Lots of factors influence the exam pass rates of a particular school's graduates, separate from the quality of education. There are the program's choices about whom to admit; graduates' experiences in supervision; decisions by students about whether to pursue MFT licensure; and on and on. So if a program's graduates performed especially well or poorly, that does not necessarily mean that the program itself performs that way. (3) To whatever degree exam passing-or-failing does reflect on a program itself, it reflects on that program's performance several years prior to the exam. When you're looking at data going back to 2004, as we are here, we're considering the impact of an education received as far back as around 2000, possibly even earlier. Programs change. (4) If you're a prospective MFT student, exam pass rates are certainly not the only things to consider when choosing an MFT program. They can be useful to include in your decision-making, but please do not let them be a powerful factor.

Got all that? Great! With those cautionary notes in mind, let's dive in. We'll focus here on the first licensing exam, the Standard Written Exam.

I've had student assistants input and cross-check the data, and we've done some analysis using Excel and SPSS (now PASW, for statistical-software purists) programs. The data shows some clear trends.

There are big differences between programs. Don't let anyone tell you that graduate programs are basically interchangeable. They may all be subject to the same MFT curriculum requirements, but some appear to be far more effective than others in preparing their students for the licensing exams. (Education is not the only influence on exam preparedness, of course, but this data does suggest that it is a meaningful one.)
Note: Try as I might, I could not get the tables to display well inline here. So they've been shifted over to the MFTEducation.com server, where they display properly. -bc
Table 1: Best and worst performing programs*, California MFT Standard Written Exam, 1/1/2004-6/30/2009 (Minimum 50 first-time examinees)
Accreditation matters. Graduates of COAMFTE-accredited programs were more successful on licensing exams than graduates of non-COAMFTE programs. While my own program at Alliant International University did better than the state average, much of the COAMFTE benefit seems to come from the strength of the University of San Diego. (I have a more detailed exploration of the link between program accreditation and licensing exam success in press at the Journal of Marital and Family Therapy.)
Table 2: COAMFTE-accredited programs*, California MFT Standard Written Exam, 1/1/2004-6/30/2009
* - Accredited as of 1/1/2004.
Size doesn't matter. Graduates of smaller programs did no better or worse overall than graduates of bigger programs. And the biggest programs were not necessarily the best. Far from it, in fact. Graduates of National University, the state's largest MFT program by number of examinees, performed well below state averages on the Standard Written Exam:
Table 3: Most first-time examinees, California MFT Standard Written Exam, 1/1/2004-6/30/2009

These are only the beginning, of course. There is a lot to be gleaned from the available data, for programs and prospective students alike. I'll be doing some additional posts with more comparisons here in the coming weeks to illustrate some more of the interesting (I hope!) things we found.

One big plus about working with BBS data is that it's all public information. So I feel an obligation to make sure others can review it, call out any errors you find, and do additional research with it as you see fit. All of the information on which these tables were based is available now at www.MFTeducation.com. There you will find the BBS source documents that we put together, as well as a searchable database so you can compare your program with others around the state. Your comments and suggestions are always welcome; I hope this is a useful resource!

Coming in Part II: Comparing for-profit programs with not-for-profit.

AAMFT, AFTA, CAMFT, IFTA, and more: A primer on MFT associations

2010-10-05T15:37:00.000-07:00

There are at least six major professional associations that cater to marriage and family therapists. Each of the organizations has great value, and each focuses its energy a bit differently, so it is useful to know about them to determine where you want to make professional connections and what activities you want your member dues to support. Of course, for each organization, there is not room here to cover all of their member benefits; I would strongly suggest following the links to each organization's web site to learn more about what they have to offer.

Note: The logos here are, of course, the trademarks of their respective owners. Like the rest of this post, they're there to be informational, and to connect you to the organizations' sites; they are not meant to indicate that the organization endorses this blog, or vice versa.

The American Association for Marriage and Family Therapy is the national professional association for MFTs. It has led the successful push to get MFT licensure in all 50 states, and now is working in support of legislation that would add MFTs to Medicare and improve employability in schools. Strengths: AAMFT is particularly known for its successes in advancing the field through research, education, and training. These efforts include publishing the Journal of Marital and Family Therapy; publishing Family Therapy Magazine, which focuses each issue on a particular clinical or advocacy topic; putting on a large annual conference; supporting the AAMFT Approved Supervisor designation and related training; and accrediting graduate programs in MFT through its accrediting arm, COAMFTE. AAMFT also has divisions dedicated to more localized efforts in US states and Canadian provinces. (Full disclosure: I'm on a consulting contract with AAMFT, focused on California educational and policy issues.)

The American Family Therapy Academy is a smaller, invitation-only organization dedicated to advancing systemic thinking and systemically-oriented services for families. AFTA produces an Annual Conference and publishes a special-topics journal, the AFTA Monograph Series. Strengths: The depth and quality of discourse within the organization is strengthened by the invitation-only membership model. The organization's strong commitment to systemic work is evident.

The International Family Therapy Association is dedicated to supporting the work of MFTs overseas and training practitioners around the world to deliver culturally-appropriate family-based services. IFTA publishes the Journal of Family Psychotherapy and sponsors the World Family Therapy Congress, an international conference of family therapy researchers and practitioners. Strengths: The Congress is well-renowned for its ability to bring together international leaders in the field who otherwise may never make personal contact. The organization's focus on culturally-appropriate care is also important when applying treatments to different populations than those for whom the treatment was initially developed.

The California Association of Marriage and Family Therapists is an independent organization (that is, separate from AAMFT and its California Division) dedicated to supporting MFTs in the state. That by itself makes the organization one that is important to the profession overall, since about half the MFTs in the country, by licensure, live in California. CAMFT produces its own magazine, The Therapist, which focuses largely on legislation, employment, and compliance issues. CAMFT also puts on an annual conference. Strengths: CAMFT has historically focused its energy effectively on state-level legislation and advocacy, and on local connections through its 29 local CAMFT chapters throughout the state.

The International Association of Marriage and Family Counselors is a division of the American Counseling Association. ACA considers marriage and family therapy to be simply one of many forms of counseling, and accredits MFT programs as specialty counseling programs. IAMFC publishes its own journal, which CAMFT has recently begun distributing to its members as the two organizations seek additional ways to collaborate. Strengths: IAMFC is seeking to grow in scope and influence through collaborative efforts, including its collaboration with CAMFT and with the National Credentialing Academy.

The National Council on Family Relations is an interdisciplinary organization focused on research and policy as they relate to family life. NCFR administers the Certified Family Life Educator credential, publishes a number of journals including family-studies leader Family Relations, and puts on its own annual conference. Strengths: The CFLE credential crosses state lines, and the organization's focus on applied research and public policy have made it a go-to source for practitioners and policymakers alike.

Each of these organizations has a lot to offer. Students in particular can benefit from them, as they each have remarkably low membership costs for those currently in school. Professional associations advance the field on many levels, improving the quality of our training, the effectiveness of our clinical practices, the employability of MFTs, reimbursement practices, and public policy. I encourage you to find the ones that will be most valuable to you, join them, and then invest your time and energy in them. Being just a number in an organization is fine and has benefits; being an active voice and an advocate for your profession is even better.

Recapping the 2010 AAMFT Annual Conference

2010-10-01T10:05:00.000-07:00

There was a lot to talk about at the just-concluded 2010 AAMFT Annual Conference in Atlanta, where more than 1,700 clinicians and researchers from around the country gathered to share the latest ideas in treatment. This year's theme was "Marriage: Social and Relational Perspectives," and this year's jump in conference attendance was well-deserved. Hitting some of the high points:

* For my money, Stephanie Coontz should be a keynote speaker every year. Last year, she talked about time-use studies and the changing face of American families. This year she gave a lively summation of her great book, Marriage: A history, putting modern marriage into a larger context. Next year's theme will be "The science of relationships," and I hope there's a way to bring her into that, too. The woman could make the history of the paper bag engaging.

* The last plenary speaker, John Witte Jr., was not quite as advertised, but started great dinner-table conversation. He had promised a speech on "Marriage, Religion, and the Law," which could have been wonderful -- a more conservative counterpoint to the arguments others made in favor of same-sex marriage. Ultimately, he barely mentioned religion at all. Which was too bad -- as I've argued before, there is a reasonable debate to be had about the role of religion in marriage (and specifically whether religious therapists should refer out same-sex couples they do not feel they can work with supportively). I really, really wish someone could put together a respectful dialogue on the topic. But for what it turned out to be, Witte's speech was valuable. His proposals for legal-system remedies to the changes in family formation and dissolution in the US were far-fetched, but started some great conversations. We all want parents to be responsible for their choices, but how do you have a legal system that best balances supporting families in need with punishing those who are irresponsible? I loved the variety of ideas about that just at my own dinner table; I'm sure similar discussions were happening at plenty of others.

* We're making great strides in the effective treatment of military veterans and their families. MFTs are ideally trained to help keep military marriages and relationships strong (or to end them more peacefully when necessary), and there was a whole track at the conference dedicated to just this kind of work. The timing could not have been better: finally, after years of struggle with the implementation process, the Department of Veterans affairs has a job description specifically for marriage and family therapists.

It's always refreshing to renew old connections and make new ones at the conference, and I especially enjoyed the opportunity to present with some of my faculty colleagues from the Alliant MFT program. My heartfelt thanks to everyone who made the conference such a success. I can't wait for next year!

VA posts MFT job description

2010-09-30T13:38:00.000-07:00

Images from the first Gulf War. www.va.gov

It's been a long time coming, but the Department of Veterans Affairs has posted its job description for marriage and family therapists. According to that document, the category applies to "VA Medical Centers, Community-Based Outpatient Clinics (CBOCs), Vet Centers, Veterans Integrated Service Network (VISN) offices, and [the] VHA Central Office." The educational requirements demand that one graduated from a COAMFTE-accredited program; just one more reason accreditation matters. (If you're wondering, the VA's Professional Mental Health Counselor category requires a CACREP-accredited degree.)

For those of you familiar with VA hiring practices, MFTs now become part of the Title 38 Hybrid category, and entry-level MFTs will be brought in at salary grade GS-9. (While salaries vary by specific location, in California this is likely to mean starting salaries in the $50s/yr, judging by social worker positions at the same salary grade.) More experienced MFTs will be at GS-11 (mid- to upper-$60s and up), and supervisors at GS-12.

Keep an eye on www.aamft.org for additional information, and the VA's job search site for new openings as they arise.

Great new books on modern marriage and divorce

2010-09-30T09:24:00.000-07:00

Quick, true or false: Half or more of the couples getting married this year will eventually divorce. We hear that statistic over and over and over again. It's wrong. The divorce rate has been in significant decline since the 1970s. By the tenth year of marriage, by which time we know that more than half of those who will ever divorce have already done so, only 16% of college-educated women who married in the 1990s had divorced. That represents a drop of almost a third since the 1970s; 23% of college-educated women married in that decade had divorced by the tenth year of marriage. (The trend runs parallel for those without a college education, whose divorce rates are consistently just a few points higher.)

Marriage is changing in the US -- and in many ways for the better. The divorce rate is definitely declining. Young people are putting off marriage, for a variety of reasons (some of which are likely economic). And therapists' knowledge of how to strengthen weak marriages grows stronger by the day. This research, on marriage itself as well as how to improve it, is the focus of Tara Parker-Pope's excellent For Better. Parker-Pope, who writes the Well blog for the New York Times, condenses current family-studies and family-therapy data into a well-paced, eminently readable and optimistic portrait of modern American marriage. Simply put, the book is fascinating. Parker-Pope is certainly a gifted writer; she is able to accurately communicate the finer points of research with a light touch, never coming across as wonky or technical. She also includes a number of self-tests researchers have designed to assess marriages, which makes the book even more valuable on a therapist's shelf.

For those couples who do divorce, they should know that modern divorce is changing, too. When Americans divorce, they are more likely than people anywhere else to remarry, and they tend to do so more quickly. Even those who do not marry are more likely to bounce from one relationship to another in the US, forming the framework for Andrew Cherlin's book, The Marriage-Go-Round. Cherlin makes a compelling case that the US is different from the rest of the world in how we think about marriage and divorce. Even better, he offers a compelling explanation, rooted in our nation's social and religious history. It too is a great read. (It also can be occasionally frustrating; Cherlin briefly dissects the half-of-all-marriages-end-in-divorce myth early in the book, only to repeatedly reinforce it later. Parker-Pope does a much more detailed job of demolishing that myth.)

Ultimately the two books are both worthwhile on their own, but they are even better in combination. For therapists wanting a comprehensive and digestible understanding of the choices Americans make in marriage, divorce and the spaces in between -- and how we can improve those choices -- read them both.

That infidelity-and-income study? Don't believe it.

2010-08-17T11:55:00.000-07:00

A recent study, presented at an American Sociological Association conference to a fawning media reception (NPR / Salon), tells us that men who make less than their wives or live-in girlfriends are five times more likely to cheat. It's bogus. Here's why.

While commentators have been stumbling over themselves to determine what the study's findings mean about gender, marriage, and society, no one seems to be bothering to notice that the study itself appears pretty useless. The major conclusion, linking income and infidelity, has a number of problems, not the least of which is that everyone -- myself included -- who wasn't at the conference is relying on a press release and subsequent media reports about it. Such reports are notoriously unreliable, often drawing ideas from generous and/or speculative interpretations of the results rather than the study itself. That said, here are three of the reasons I'm particularly skeptical:

1. Do the math. The National Longitudinal Survey of Youth, upon which the study is based, followed about 9,000 individuals -- surely a healthy sample size. But the infidelity study examined only those who were married or with a live-in partner for more than a year, which is a much smaller subset. And of those, only seven percent of men and three percent of women actually fessed up to cheating during the study's six-year period. So, let's be generous and say that two-thirds of the NLSY group met the relationship-status criteria (n=6,000). And we'll presume that roughly half are of each gender (3,000 men and 3,000 women). That leaves us with about 210 men who have fessed up to infidelity in this survey. Of those, it is not clear from the media reports how many were in situations where the male earned less than his partner; other recent research suggests about a third, or fewer than 80 of those reporting infidelity, were in such a relationship. And remember, we're being generous because we do not have the actual numbers. To be sure, 210 male cheaters is still a decent sample, and it could be enough to draw meaningful conclusions about links between infidelity and income (among other factors). But it still is not a lot. In fact, it probably is a lot less than the number of participants in the survey who actually cheated. Remember...
Updated 2010-08-20: LiveScience.com (which has more details on the methodology, and as an added bonus, commentary from Stephanie Coontz) is reporting that only 3.8 percent of men, and 1.4 percent of women, admitted to cheating in the study. That's not exactly true; on average, 3.8 percent of men and 1.4 percent of women admitted to cheating in any given year of the six-year study, at least according to the press release.
2. People lie. A major income discrepancy in the relationship may be a good reason for men to simply be more honest about their cheating. Sure, you could argue, if the wife/girlfriend finds out then the gravy train ends. But if the man is in a relationship for the money, and not emotionally committed, why on earth would he lie to an anonymous survey about his cheating? There is little incentive to, and there is no cognitive dissonance to resolve over telling the truth. On the other hand, if he is emotionally engaged, and is in the relationship for reasons other than money, he may find it safer (and more palatable) to hide any previous infidelity. If all that sounds awfully speculative, well, that's the point. People lie on studies like this, and we do not always know who will be most likely to lie or why. Yet commenters (and, too often, the researchers themselves, as seems to be the case here) treat the findings as truth in spite of their huge flaws, and then seek to divine an explanation.
3. Account for other factors, like age, education, and religion, and the income-infidelity link vanishes. That inconvenient fact is actually in the press release, but of course, no one is paying attention to it. Does earning more than your man make him more likely to cheat? the chatterers are asking. In a word, no -- the income issue appears to (at best, and even this has big holes) correlate with, but not be a cause for, cheating.

The trouble with any study of undesirable behavior that relies on self-reports is that it is impossible to know what we're really studying -- the behavior itself, or the act of reporting it. Only a more carefully (and expensively) constructed study could parse that out. In the meantime, move on. Nothing new to see here.

Making sense of the 2010 CAMFT "Typical MFT" survey

2010-08-16T09:54:00.000-07:00

CAMFT came out last month with their biannual “Who Is the Typical California MFT?” article, summarizing a survey of hundreds of members about themselves and their careers. The article is presented largely as narrative, without much in the way of interpretation – the way a good summary of results should be. To me, three things stood out in this year’s numbers. Bear in mind with all of these that, because it is just a survey of California folks, when I say “MFTs” I am really referring to “California MFTs.”

1. The economic news is not great, but it is not as bad as it sometimes seems. The average income among survey participants[*] is down almost 6% from the 2008 survey, to $52,886 from $55,890. But the news could be a lot worse. For one thing, CAMFT does not explain what they mean by “average” – that is, whether are reporting the mean or the median. If they are using the mean, it is entirely possible that some of this downturn is explained by the highest outliers making a bit less money. They do note that both “tails” of the frequency distribution – those making above $80,000 and those making below $20,000 – have increased in frequency over 2008.

2. The increase in MFT incomes over the last eight years is almost fully accounted for by those with doctoral degrees. The incomes of MFTs at the masters level have been effectively flat since 2002, rising only from $47,851 to $50,689. This increase is less than what would be expected from inflation alone. Doctoral-level MFTs, however, have seen their incomes grow significantly – including in the current economic downturn. I’ve turned CAMFT’s data since 2004 into a graphic to show the difference:

Since 2004, while masters-level MFTs have seen little to no increase in income from the profession, those with doctoral degrees have seen their incomes rise by almost $10,000 a year, from $62,885 in 2004 to $72,165 in 2010. Still wondering whether to get that doctorate? I’m speculating here, but there are a couple of reasons why the doctoral-level MFTs are continuing to see rising incomes: 1, those with doctoral degrees are able to teach in academic institutions, where they may have more job and income stability than those in private practice; 2, many of those licensed MFTs who have doctoral degrees may also be licensed as Psychologists, who are reimbursed at higher rates than MFTs when paid by most insurance plans.

3. Your web presence is not as important as your physical presence. For all of the excitement surrounding clients’ abilities to find therapists through internet searches, most clients still are not coming to therapy that way. Respondents noted that referrals came most often from other clients and from colleagues. Managed care companies were third on the list, followed by physicians, and (in a single choice) family/friends/neighbors. Internet searches were eighth on the list. So rather than spending your next Friday tinkering with your web site, you may be better off attending a local meeting of your CAMFT Chapter or AAMFT district. There’s no apparent substitute for real-world networking.

* A number of cautionary notes seem important here. For one thing, we’re talking about a survey with a 16% response rate – that, in and of itself, makes the numbers a bit dubious. That said, they’re pretty consistent with past surveys, both demographically and in the other data. So, there may be some response bias (and it seems especially likely that those at the low end of the income spectrum would be less willing to talk about it), but it’s difficult to know how that plays out. As mentioned above, CAMFT does not specify whether they are talking about a mean or a median in their income numbers; the median would probably be a better metric, but it seems more likely that the mean is what’s being reported. Finally, with all of the income numbers, CAMFT asked participants to state their pre-tax income specifically from the practice of the profession. That may or may not include supplemental activities like teaching courses as an adjunct faculty member, selling workbooks or other study materials, and so forth. Other surveys ask for total income, which has its own pitfalls. The difference in how the question is asked may account for differences from other surveys of the profession.

Reference:
Riemersma, M. (2010). The typical California MFT: 2010 CAMFT member practice and demographic survey. The Therapist, 22(4), 28-36.

From the AAMFT Research Conference: The one question that can improve depression treatment outcomes

2010-07-18T21:10:00.000-07:00

A large number of clients who seek treatment for depression also are having difficulty in their marriages. New data suggests that one question can dramatically improve patient outcomes on both problems: Which came first?

That's the finding Steven Beach, a professor at the University of Georgia, discussed at this weekend's AAMFT Research Conference in Alexandria, VA. Research has shown for many years (1, 2) that marital satisfaction and depression can be greatly improved at the same time through couples treatment, regardless of which problem came first. However, new data from Beach and his colleagues suggests that when women are struggling with both depression and marital problems, individual therapy for depression will have negative effects on the relationship if the marital discord came first -- suggesting worse outcomes for the depression as well.

Why should this matter to MFTs, who are eminently qualified to identify and treat both issues? Because most depressed people don't start by seeking treatment from a family therapist. According to a 2009 NAMI survey on depression, people with depression usually receive treatment from their primary care physicians. Just 38% receive their primary depression treatment through a mental health professional of any kind. Physicians tend to treat depression with medication and/or referral for individual therapy. They rarely refer for couples therapy, in spite of the research supporting such referrals. The list of possible reasons for this disconnect is long, but some reasonable guesses include that physicians may not know the research, may not have a trusted marriage therapist to whom they can send clients, or simply may not think to ask depressed patients about relationship difficulties (an area of struggle patients may not bring up on their own).

Beach and his colleagues believe that the link between depression and relationship difficulty is so strong that physicians ought to screen for relationship problems whenever they are diagnosing a patient with depression and considering treatment options. They developed a simple 10-item screening measure for relationship problems, with an 11th question for those who show relationship difficulty: Which came first?

Notes: Two quick things about the research base here: 1, the studies of marital therapy to treat depression have universally, as best as I can tell, looked at depressed women. Whether the suggested treatment course and likely outcomes would be the same with depressed men is open to question. 2, while studies have looked at marital therapy and marital satisfaction, there is no reason to believe that non-married people in committed relationships have a different kind of link between depression and relationship difficulty. The screening instrument can be used for married and nonmarried couples alike.

UNLV's MFT program will survive

2010-07-17T14:28:00.000-07:00

This post was originally posted on June 5, 2010 under the headline "UNLV MFT program to close." The original post follows. It is updated below. -bc

The Las Vegas Sun is reporting that the state's Board of Regents has approved the closing of UNLV's marriage and family therapy program. The decision was based on state budget cuts, which also have forced the closing of five other UNLV programs. This appears to be the first COAMFTE-accredited program to be shuttered due to state budget cuts.

Update 7-17-2010: As noted in the comments, the program has been saved thanks to some thoughtful maneuvering by its faculty. Though the MFT program will no longer have its own department, the program will continue under a new administrative structure. This is wonderful news to students, faculty, and colleagues alike. The UNLV program is the only COAMFTE-accredited program in the state and is vital to the region.

From the AAMFT Research Conference: Does marriage education work?

2010-07-17T12:17:00.000-07:00

Marriage education (also known as relationship enhancement or RE) has gotten a big, warm spotlight lately. A recent big-deal writeup in the Washington Post hit on the high points: Marriage education programs are big business, they have a lot of federal money supporting them, and there's not a lot of research on them. Do they work?

That was the basic question tackled yesterday by Howard Markman at the AAMFT Research Conference in Alexandria, VA. In general, it looks like the research base for such programs is growing but still fairly small relative to the number of RE programs in existence. Markman and his colleagues located 30 studies examining 21 different programs since 2002 -- meaning that a large number of programs offered at the annual SmartMarriages conference have not been researched at all. The research that does exist is usually promising, but not definitive: programs are generally shown to produce short-term improvements in couple satisfaction and communication skills. However, there have not been studies addressing whether these programs actually do what they set out to do, reducing the risk that couples will eventually divorce over the long term.

The federal government has been running a huge study that should be able to offer clearer answers. Involving eight sites and more than 5,000 couples around the country, the Building Strong Families (BSF) project sponsored by the Administration for Children and Families is testing voluntary RE programs offered to unmarried couples who are expecting or recently had a baby. The project just released its 15-month follow-up data, and the news is not good:

When results are averaged across all programs, RE did not make couples more likely to stay together or get married. In addition, it did not improve couples’ relationship quality.

As Markman was quick to note, the news was not all bleak. It would be more accurate to say that couples didn't finish the programs than it would be to say that the programs didn't work; with the exception of the project's Oklahoma site (which performed much better than other sites in a variety of ways), only 9% of couples completed at least 80% of the relationship enhancement curriculum offered to them. That's a big problem. Where couples did tend to finish their program -- at the Oklahoma site -- they were more likely to still be together at the 15-month follow-up, and experienced a number of other measurable improvements as well. Furthermore, only the Oklahoma site used a program that included most of PREP, one of the best-known and more well-researched relationship enhancement programs around. Other sites used less established curricula.

The study will be releasing its 3-year follow-up data in 2012. As Markman noted, the 15-month followup may simply be too early to see the hoped-for impact on marriage that these programs would offer; by definition, preventing marriage breakup is a long-term goal. It is possible that changes will emerge over time. Until they do, however, RE programs will continue to face skepticism. Which is good, if it drives more research that will develop programs that really do ultimately meet their preventive goals.

San Diego County to get MFT stipend program

2010-07-16T07:19:00.000-07:00

The San Diego MFT Consortium has been awarded a $350,000 grant to launch a stipend program for marriage and family therapy interns working in public mental health. The program will largely mirror the highly successful Los Angeles County MFT stipend program, which awards $18,500 stipends to MFT Interns who agree to work for at least one year in public mental health in an underserved area. More than half of the awardees in the LA program have been bilingual, helping meet a major need in the county's mental health workforce.

I'll add detail about the San Diego County program as it becomes available.

Can MFT interns pay for supervision?

2010-07-13T16:23:00.000-07:00

Aaron Feldman is frustrated. He's spent several months telling the BBS, AAMFT-CA, CAMFT, and anyone else who will listen that he can't run a therapy business legally and be successful in the state of California. No one has told him he's wrong.

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.

From DC: Update on MFT inclusion in Medicare and school programs

2010-03-19T14:43:00.000-07:00

I'm at the AAMFT Leadership Conference in Washington, DC, where Division leaders from across the country have spent the last three days visiting our federal representatives. Priorities this year include Medicare inclusion and adding MFTs as named providers within the Elementary and Secondary Education Act (otherwise known as No Child Left Behind). Before I go to the details on the visits, some words of praise: this was the first time that AAMFT's California Division and CAMFT, an independent organization of California MFTs, have combined efforts on their federal advocacy visits, and it went swimmingly. CAMFT's lobbyist and leaders were kind, cooperative and helpful throughout, and I hope their experience of AAMFT was similar. Legislators and their staff people seemed impressed with the level of cooperation. As to the key issues, here is where we currently stand:

Medicare. As we were starting our second day of hill visits to California representatives on Thursday, we were greeted with bad news: the inclusion of MFTs as providers under Medicare, which had been part of the House health care reform package but not the Senate package, was pulled out of the reconciliation bill that will be voted on as early as next week. There is a slim chance that MFT inclusion in Medicare could still be accomplished this year through a different piece of legislation, but at this point that appears unlikely. On a more positive note, though, there remains significant bipartisan support in both chambers for adding MFTs in Medicare, as it would improve access to mental health care for seniors and those with disabilities. For a video of Senator John Barrasso (R - Wyoming) discussing the importance of this issue, click here.

School programs. MFTs can provide services to school populations under the Elementary and Secondary Education Act (ESEA), but because we are under the somewhat vague category of "other providers," most programs do not seek to include MFTs when they apply for federal grant funding under ESEA. Adding MFTs as specifically named providers would improve the availability of behavioral health services for children. It also comes at no cost, which is helpful in seeking bipartisan support. Currently, these changes are in a House bill (HR1710) that has sponsors from both parties. I always enjoy the Leadership Conference for the trips to the Hill as well as the opportunities to connect with divisions from around the country. I'll have another update from the conference in the next few days.

MFT named one of 50 best careers for 2010

2009-12-30T12:14:00.000-08:00

US News and World Report has named marriage and family therapy as one of the "50 best careers" for 2010. They sum up the profession nicely:

While some counselors focus on the behavior of an individual, marriage and family therapists go a step further, addressing mental-health issues within the context of the family. By counseling couples, families, or individuals, marriage and family therapists can tackle a host of problems: adult schizophrenia, substance abuse, anorexia, and marital conflict. Today, marriage and family therapy is considered a "core" mental-health profession, alongside social work, psychiatric nursing, psychology, and psychiatry. More than 1.8 million people are currently receiving treatment from a marriage and family therapist.

Demand for MFTs is expected to grow substantially over the next decade, the report says. If MFTs ultimately earn inclusion in Medicare, demand could increase far beyond what US News predicts.

Money for MFTs

2009-12-15T14:02:00.000-08:00

A number of state and federal programs offer tens of thousands of dollars in stipends and loan reimbursements for marriage and family therapists to advance their careers. Generally, these programs aim to help bring mental health services to underserved areas and to reward therapists who dedicate themselves to such communities. Here are just a few of the programs MFTs may find enriching.

The federal National Health Service Corps program offers a whopping $50,000 in loan reimbursement, on top of the salary one would already make in an eligible position, for two years of service. More information can be found at nhscjobs.hrsa.gov.

Also on the federal level, the Indian Health Service (IHS; www.ihs.gov) offers a similar program, awarding $20,000 per year for two years of service at an IHS site. (A cautionary note: MFTs are legally recognized for employment within IHS, but appear to fall within "other professions as determined by need" in the loan repayment program.)

The American Association for Marriage and Family Therapy (AAMFT) / US Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship Program awards stipends of $20,000 per year, plus funding to conduct research and travel to conferences and trainings, to doctoral students in MFT programs. These awards are renewable up to three years.

In California, there are additional state-based stipend and loan reimbursement programs. The awards offered by each of these programs are in addition to the salary one would already earn in an eligible position.

The California State MFT Stipend Program provides awards of $18,500 per year to MFT Interns who agree to work in public mental health positions in underserved areas for at least one year. In 2009, 60 of these stipends were awarded through the statewide MFT Consortium, which covers most of the state; Loma Linda University and CSU-Chico each administered a handful of additional stipends through the same state fund.

There is a separate Los Angeles County MFT Stipend Program, which for 2009-2010 is awarding 36 stipends of $18,500 with similar service requirements.

Finally, the state also offers MFTs and MFT Interns its Mental Health Services Provider Education Program, which awards up to $15,000 in loan reimbursement for two years of service in an underserved area. Technically, this is two separate programs, as its funding comes through two distinct streams (license renewal fees, and the Mental Health Services Act). As a practical matter, though, they're the same; they use the same application form and are administered collaboratively.

Are you aware of other federal or state-based programs that should be added to this list? Email me at bcaldwell (at) alliant (dot) edu and let me know, and I'll be happy to expand this post.

California LPCC law passes; should MFTs dually license?

2009-10-26T12:13:00.000-07:00

Late in the evening of October 11, Governor Schwarzenegger signed California Senate Bill 788, adding Licensed Professional Clinical Counselors (LPCCs) to the state's masters-level mental health professions, alongside MFTs and LCSWs. Licensure by grandparenting will take place over a six-month period in 2011, with routine licensure starting January 1, 2012. Should MFTs dually license?

For most, there would be no benefit, and significant added expense. Since licensure is inherently a state-based activity, there is no reason to believe that licensing as an LPCC will make one's license more portable; in fact, a license obtained through grandparenting may have greater trouble getting recognized in another state. Add to that the still-unclear question of whether California will recognize national exams in counseling (national exams in MFT and Clinical Social Work are not recognized in the state), and the likelihood of a portability benefit grows even slimmer. The added expense of two renewal fees could be little more than wasted money.

There is, however, a legitimate reason why some MFTs may want to dually license: They want to reflect what their professional orientation has been all along. California was the first state in the US to license MFTs, and the last in the country to license LPCCs. As a result, some who work under the MFT license do so because that was the masters-level entry point into a career in mental health, and not because they particularly identify with systemic concepts. For those therapists, the Clinical Counselor license is probably a better fit.

They will not, however, want to switch over entirely. Counselors will enter the mental health marketplace in California more than four decades after MFTs did, and will need to fight for themselves every battle MFTs waged and won for recognition in hiring and reimbursement. They'll be able to make up ground, but it will be many years before counselors can claim the kind of recognition and stature in the state that MFTs claim today, thanks to decades of good work by CAMFT and AAMFT.

Blogging the AAMFT Conference: Sunday

2009-10-04T17:16:00.000-07:00

The AAMFT Annual Conference wrapped up Sunday morning, as the last die-hards snuck in one last 3-hour workshop before drifting up to the Sacramento airport and back home. I was a presenter on Sunday morning, but only if you use the word "presenter" loosely; I led a panel discussion on licensing exams.

Before you go into the automatic response (which is, I believe, "zzzzzzz"), you should know there was one significant piece of news to come out of it: California's Board of Behavioral Sciences and the Association of Marital and Family Therapy Regulatory Boards, who develop the California and National MFT Exams respectively, have agreed to collaborate on their next occupational analyses. It's a small step but a significant one, as it will at least allow for an apples-to-apples comparison of the practice of MFT in California versus around the rest of the country. That kind of comparison would be necessary in any discussion of California eventually moving toward use of the National MFT Exam -- something I believe in very strongly.

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As is the case every year, I leave the conference energized, with many new research ideas, new potential collaborators, and new respect for the amazing work taking place in our field. I also leave Sacramento with renewed appreciation for just how clinically strong our Alliant students are and will be; it wasn't at all unusual to see the best questions in any workshop -- and often the best answers as well -- coming from people with orange "Alliant" stickers on their badges. Great work, everyone. See you in Atlanta next September.

Blogging the AAMFT Conference: Saturday

2009-10-04T00:08:00.000-07:00

Susan Johnson stole the show with her plenary presentation at the AAMFT Annual Conference in Sacramento today. Presenting without Powerpoint slides was itself refreshing, but she said several things in a far more eloquent manner than anyone else has this weekend. I'm paraphrasing, but here were a couple of my favorites:

Therapy needs higher goals than simply reducing conflict. We get better every day at actually creating new love and bonding.
Emotions have an exquisite logic to them that is not to be ignored or dismissed. For EFT or any other kind of therapy, clients should not expect that they need to leave their intellect at the door.
Connection with a partner soothes the brain. MRI studies show that an expectancy of shock is mediated when in physical contact with a partner.
When it comes to sex, research is clear: Practice *and* emotional connection make perfect.

The workshops I attended today were good informationally, but neither was put on by especially dynamic presenters. I learned about marital satisfaction instruments and online education, both of which are eminently practical -- one of the things I like most about the conference.

The evening presentation by Dorothy Becvar was a nice review of the history of the field in terms of its concepts and contributions to mental health. A good (and brief) final plenary to a very good conference. I've heard that the other workshops were greatly varied this year in terms of quality, but that those that were good were incredibly good. The conference concludes tomorrow with a set of 3-hour workshops, including one I'll be moderating on the licensing exam development process. More tomorrow.

Blogging the AAMFT Conference: Thursday/Friday

2009-10-02T23:21:00.000-07:00

Today was the first full day of the AAMFT Annual Conference, which is in my former hometown of Sacramento. It's been great catching up with old friends, colleagues, and students -- this event has become as much a reunion for me as an educational experience. Still, I've learned a lot. Here's what I've learned last night and today:

We've come a long way. The opening plenary on Thursday night was an appreciation of the history of our field, and a celebration of finally accomplishing licensure in all 50 states. Bruce Kuehl did a great job with it, and I may be adding clips from this to the MFT Theories course next year.
I need to start a Facebook group. I'll call it "MFTers for Changing MFTers for Change." But then a subgroup would probably spring up to try to change my group, and I don't want that kind of trouble.
Family systems and psychoanalytic principles are not mutually exclusive. Okay, to be fair I already knew that. But Richard Scwartz's presentation of Internal Family Systems made me believe this more strongly than I had before.
COAMFTE accreditation matters. I already knew this too, but now I have more evidence to back it up. Jeff Larson was kind enough to fill in for Russ Crane, and Jeff joined Mary Moline and I in presenting a workshop on the things that set COAMFTE programs apart. Jeff handled curriculum, pointing out that MFTs are required by licensure laws to get far more education and experience in family therapy than any other profession. Mary took on public mental health, reviewing how the COAMFTE programs in California and around the country are uniquely positioned to integrate changes in public mental health approaches like the recovery orientation. And I took on licensure, pointing out that graduates of COAMFTE-accredited programs get further, faster in the licensure process and are more likely to pass their exams than graduates of non-COAMFTE programs.

Overall, the AAMFT Annual Conference has again earned its spot as the most valuable and rewarding continuing education event I attend during the year. More tomorrow.

Blogging the AAMFT Conference

2009-09-29T16:53:00.000-07:00

I'm headed to Sacramento on Thursday for this year's AAMFT Annual Conference, where leaders in the field from around the world gather to share clinical and research insights. It's a great event every year, and with plenary presentations from Bruce Kuehl, Richard Schwartz, Susan Johnson, and Dorothy Becvar, this year promises to be outstanding.

I'll be posting as frequently as I can while I'm there; you can also tune into my Twitter feed (@benjamincaldwel) for additional -- if very brief -- commentary.

MFTs targeted by spam, scams

2009-09-29T15:18:00.000-07:00

Marriage and family therapists around the country have been targeted by scams via phone, email, and postal mail. Here are warnings on three of the most common recent ones.

The pre-payment scam. Both AAMFT and CAMFT have warned their members about this one. In a therapy-specific variation on an old scam, a therapist receives a call from someone looking to set up therapy for themselves or a family member, telling the therapist that the client is not yet in their city but will soon be arriving (usually for work or school). The caller asks to prepay for several sessions in advance, and mails a check. Within a few days, they call back to say the "client" has had an emergency change of plans, and the money needs to be refunded immediately. Only after the therapist has issued a refund do they discover the original check has bounced.

What to do: This scam could be stopped at several points in the process. 1) Don't accept payment for services from someone you've never met in person. 2) If you do accept pre-payment, do not accept pre-payment for more than one session at a time (this at least limits your potential losses). 3) You may choose to not accept check payments at all; many therapists now accept fees via credit cards, which offer much better fraud protection. 4) If you do accept checks, your bank may allow for instant electronic check processing, so you'll know right away if a check will not be covered by the issuing bank. 5) If you accept prepayment by mailed check -- and again, it's far better not to -- have a clearly written refund policy that establishes your process and timeline for issuing refunds on services paid but not received. This may be part of your cancellation policy, which is related. 6) Never issue a refund before you have actually received the funds in your account.

The counselor scam. A privately-owned company called the American Psychotherapy Association (I will not link to their site because they don't deserve the traffic, but you can Google it if you're really interested) has been blanketing California with brochures promising MFTs that they can become "grandparented" into being a "Board Certified Professional Counselor." The brochure appears to be carefully crafted to mislead MFTs into thinking that the certification might equate to LPC licensure (it does not and will not), without actually saying anything that is factually untrue. The organization does offer a Counselor Certification, and California MFTs can be "grandparented" into it. At least in the sense that the requirements for that designation will change if California eventually licenses professional clinical counselors, as it may soon do.

What to do: Look, I don't know anything about the American Psychotherapy Association (not to be confused with the far better-known APA); they do have a few folks I highly respect on their board, they put on an annual conference, and they may well be a worthwhile organization. But this is a callous marketing effort designed more to take advantage of California MFTs' lack of knowledge about how LPC licensure might work than anything else, and it greatly tarnishes their reputation in my eyes. If you receive their mailer, throw it away.

The "men's movement" spam. On the CAMFT listserv, there have been several posts from therapists who received an email threatening to take action against them based on their name and contact information being listed on AllAboutCounseling.com, one of many sites that host therapy-related articles, blogs, and a therapist directory. (I'm naming them because they're a victim here, though I would caution that this site was unknown to me before researching this post.) In the email that's been going around, the attacker -- who doesn't deserve to be named or linked to -- suggests that there are dangerous and false articles on the site, and that therapists should be fearful of associating themselves with it. Having reviewed what's actually on the site, I can't say it's all that good, but it's certainly no worse than what's on a hundred other therapy- and counseling-oriented sites. What seems to have gotten this attacker's anger up are the articles about women and women's issues. He claims to be part of a "men's movement," but a men's movement that uses threats to get its way does a massive disservice to the term "men's movement" and to men in general.

What to do: This is a tough one. If you're listed on the web site (and not that many are), you can ask to have your listing removed... but should you? That would seem to be giving in to the threat. On the other hand, if you leave your listing up, this guy could make good on his threat, spewing bile onto the internet and attempting to associate you with his attacks. Yes, his actions are wrong, threatening, juvenile bullying. But some therapists understandably want to be nowhere near anything that looks like controversy. Is it a battle you want to fight? That's a judgment call.

Generally speaking, therapists can avoid scams like these by using common sense; if a propsective client sounds too good to be true, asks you to violate your own policies or standards, or raises other red flags for you, consult with colleagues, supervisors, and your professional associations. And if you've been the victim of such a scam, the worst thing to do is stay silent out of embarrassment; that only allows the scam to continue. You serve the profession and the public well by alerting others to such risks.

CAMFT steps forward on same-sex marriage

2009-09-13T18:13:00.000-07:00

At its board meeting in Sedona, AZ over the weekend, the California Association of Marriage and Family Therapists (CAMFT, not affiliated with AAMFT or its California Division) voted to support marriage equality for same-sex couples. This is a significant step forward for an association that had spent months struggling with the issue.

As a quick recap, CAMFT has been mired in controversy following their unwillingness to make any kind of statement about same-sex marriage or parenting. They made matters worse with a broad anti-discrimination statement that, while fine on its own, failed to address any of the relevant issues members had been asking CAMFT to address. Then they made matters worse again with the publication of several hateful and homophobic articles on the topic. Executive Director Mary Riemersma and the CAMFT Board both eventually apologized for the articles, and the California Therapists for Marriage Equality organized to try to push CAMFT toward a more socially and scientifically responsible stance.

Angela Kahn, who serves on the board of the Los Angeles chapter of CAMFT, reportedly gave an impassioned presentation to the statewide board in Sedona, systematically dismantling every possible reason for CAMFT's continued silence on the issue. The board then voted 9-1 to endorse marriage equality.

Pending their permission, I'll post the full text of the statement here.

I'm elated that CAMFT is be moving in the right direction, finally, on same-sex marriage. I am hopeful that the positive movement and responsiveness CAMFT is showing on same-sex marriage will extend to other areas as well.

Health care reform likely to benefit most MFTs

2009-08-18T17:40:00.000-07:00

At this point, it's too early to know exactly what a final health care reform bill will look like -- there are still several different proposals coming out of several different Congressional committees. However the final legislative package winds up looking, if health care reform is passed, most MFTs are likely to benefit. The only questions are "How?" and "How much?" Individual MFTs can gave tremendous impact on the answers to those questions.

Individual health insurance coverage. Most MFTs work either in private practices and/or in small businesses (including nonprofit organizations) that may or may not offer health benefits. For these therapists, insurance is often both expensive (see Kaiser Family Foundation chart, left) and difficult to come by. AAMFT does its part in helping members locate insurance options, but can't do much when it comes to controlling costs. Health care reform is almost certain to help this large proportion of MFTs by making health care more affordable and removing barriers to coverage (e.g. pre-existing medical conditions).

Medicare reimbursement. Multiple House and Senate bills this year include provisions that would make MFTs eligible for reimbursement through Medicare. These bills may eventually be absorbed into the large-scale reform bills -- indeed, one such bill (HR3200) already includes specific provisions for bringing MFTs and LPCs into Medicare -- and if so, it will be vital that the provisions for including MFTs are kept. However, Medicare inclusion is currently less certain. AAMFT, AMHCA, ACA, and CAMFT are working together to counter the inaccurate claims of opponents, and are likely to need your help in the coming weeks to preserve this important part of health care reform. Stay tuned. The profession has made great strides in the past several years toward Medicare reimbursement, and with luck, this will be the year when our work pays off.

Does it matter that 80% of MFT interns are women?

2009-08-14T16:37:00.000-07:00

If you have been to see a therapist lately, I'd bet good money I can guess the therapist's gender based on their licensure. You saw a psychiatrist? Probably male (75 percent as of 1996, though declining since). Anything else? Probably female. The shift among psychologists has been most overwhelming: 72 percent of 2005 doctorates were women, compared to just over 20 percent in 1970. Clinical social workers, professional counselors, and family therapists are all likely to be women.

It would be naive, at best, to say that women are more naturally drawn than men to "helping professions." Lots of professions could be categorized as "helping," including surgery -- one profession that is still fairly gender-balanced. So what actually causes the discrepancies in psychotherapy?

Education. In social work and family therapy, the female majority continues to swell, due in no small part to larger trends in education. Women are now significantly more likely than men to start college, finish college, and go on to graduate school. In California, among those who have their graduate degrees and are working toward licensure as MFTs, a whopping 83 percent are women. An even larger 86 percent of those working toward clinical social work licenses are women.

Money. Are men staying out of these professions for simple economic reasons, the same reasons they seem to stay away from craft-selling web sites? Perhaps. Some evidence suggests that as professions shift toward higher proportions of women, pay rates in those professions decrease. If men are making career choices based on improving their chances of good pay, family therapy is something of a gamble. Pay averaged about $55,000 per year as of 2002, but varies widely based on work setting. It is certainly possible to make a six-figure salary in the psychotherapy world -- I know some who were able to do so even very early in their careers -- but it is not common.

Attitudes. Women in medical school in the UK demonstrate more positive attitudes toward mental illness, psychiatry, and psychiatric patients than men do. This mirrors findings from the general population in the US, where men are more likely than women to see mental illness as a personal failure. This issue gets more complicated once other gender stereotypes are thrown into the mix: In one recent study, men and women were both less likely to view "gender-typical" mental health symptoms (a man with alcoholism, a woman with depression) as genuine mental disturbances, and less inclined to help, compared with gender-atypical symptoms.

Relational factors. More than men, women in the US believe it is their responsibility to be caretakers of relationships. This element alone may be enough to explain the disproportionate gender balance in psychotherapy, as women appear to be more attuned to relational issues generally and health issues specifically.

All of these possible explanations lead us to the bigger question: So what?

Does it matter that such a large majority of therapists, especially early-career therapists, are women?

In a word, yes. It matters. It matters because graduate school continues to become more expensive, and if the genderization of the field puts downward pressure on salaries as noted above, it may become harder for therapists to make a living.

It matters because men already are unlikely to come to therapy in spite of its likely benefits; male therapists (and this is certainly arguable) may be better able to convince men to come to therapy, and to stay in therapy long enough to benefit.

It also matters because of the larger message it sends -- if men and women truly share responsibility for the success of their marriages and families, how is that message reinforced with a marriage and family therapy profession that is practiced largely by women, for female clients?

Of course, none of this should be read as a value statement about therapists of either gender. We are seeing in the MFT world a trend mirrored throughout higher education and social services professions. It is important that we start asking now what this genderization will mean, whether it is a trend worth trying to change in MFT (certainly not a foregone conclusion; this could be well argued either way), and if so, how that might be done. I welcome your thoughts.

What's in a name? "Couple" v "Marriage" and family therapy

2009-07-24T19:13:00.000-07:00

Marriage and family therapists (MFTs) work with individuals, families, and couples of all types. We assess, diagnose and treat the full range of mental and emotional disorders. So, the title "marriage and family therapist" doesn't provide the whole picture of what we do.

Should the name of the license be changed?

Several MFT programs have changed the name of their degree or even their department to "Couple and family therapy." This is much more reflective of the broad scope of couples with whom we are trained to work. But there would be major tradeoffs involved in changing the name of the license:

Advocacy work for the profession relies on educating legislators and their staff about who MFTs are and what we do, building our reputation and their sense of MFTs' qualifications. Changing the name of the license would set back our name recognition among those legislators, and require us to start again on that process of educating them about what may seem to them to be a brand new profession. It also would mean that a massive number of state and federal laws and regulations would need to be updated with the new name, a process that would divert resources away from advancing the profession to focus instead on preserving it.
Educating the public would be equally challenging. Our current title does do a nice job of differentiating our history and philosophy from other mental health licenses. For tens of thousands of clients and referral sources, the confidence they have in seeing or referring to MFTs may be undermined if the license name were to change. (However, many within mental health are quick to say that clients do not care about a therapist's license type; they only care whether the therapist can help them in their particular circumstances.)

On the other side, there are two arguments to be made in favor of changing the name:

One is essentially the scope of practice argument I raised in the opening paragraph. MFTs do much more work with individuals, couples, and families of all kinds than the name implies. Changing the word "marriage" to "couple" does not fully resolve this, but it steps in the right direction.
The other argument ties in closely with the ongoing debate around same-sex marriage; no matter how clearly we state that all couples who commit to each other and their children deserve equal protection under the law, it can appear discriminatory to have the word "marriage" in our title when some couples are not allowed to legally marry.

While the marriage equality debate will likely be eventually resolved, the first point seems to me to be a fairly permanent one. And I must admit, given the strong arguments that can be rightly made on both sides here, I have not reached a point where I can confidently say either that we should, or should not, change the name of our license.

I'd welcome your thoughts.

CAMFT director apologies for articles opposing same-sex marriage

2009-07-01T13:37:00.000-07:00

In a message on the organization's web site, CAMFT Executive Director Mary Riemersma has apologized for the association's publication of several articles opposing same-sex marriage. The apology is sincere, but the bigger issue remains: CAMFT is alone in the mental health world in its refusal to seriously address same-sex marriage.

As background, CAMFT (the California Association of Marriage and Family Therapists, which is has no affiliation with AAMFT or its California Division) has been harshly and rightly criticized by members, educational institutions, and in the media for their failure to make any kind of comment on same-sex marriage. Every other major mental health organization (APA | American Psychiatric Association | NASW | AAMFT) has taken a stand on the issue, and it is especially relevant to marriage and family therapists. The CAMFT board response has been underwhelming in the face of such criticism, issuing only a broad non-discrimination statement (members only) that sidestepped the important questions entirely.

In order to look like they were doing something on the issue without actually doing anything about it, CAMFT chose to publish a variety of articles supporting and opposing same-sex marriage in the May/June 2009 issue of its magazine, The Therapist. The sections were accompanied by a clear statement that while the articles presented a variety of viewpoints, the organization was not endorsing any of them.

The "pro" articles in the magazine were largely culled from scientific journals, as the science around the issue is quite clear. The origin of the "con" articles is unclear. Whatever their origin, their logic was horrible, and their arguments ranged from the potentially-worth-discussing to the blatantly homophobic and inflammatory.

Executive Director Mary Riemersma has now apologized for the publication of the "con" articles, and the entire issue of the magazine has been removed from their web site. (The next logical question, "Why were the 'pro' articles removed too, when there wasn't a problem with them?" actually is answered in CAMFT's non-stance on the issue. Leaving up the "pro" articles while taking down the "con" would appear to be endorsing the pro-same-sex-marriage point of view. As long as CAMFT is refusing to take a position, they were obligated to take down both sides.) The apology, which appears on the organization's web site but is restricted to members, reads:

I am sorry that the objectionable articles appeared in the prior issue of The Therapist and that many found them offensive. I too found them distasteful and did not think they were credible. We were trying to create a balance of views and there was a paucity of articles submitted opposing marriage equality. If I had it to do over, we would have rejected the articles. Our ethics for the profession do not condone homophobia, I do not tolerate homophobia, and neither does the CAMFT Board. Let me know what we can do to overcome the unintended harm that some believe we have caused.

It's not an outstanding apology, as apologies go (the phrase "these articles were homophobic," or anything to that effect, is conspicuously absent, and "some believe" is a little grating), but it's about as far as Riemersma can go. She's responsible for the operations of the magazine, but the board determines CAMFT policies. And by staying silent on such an important issue, the CAMFT board wades father out of the mental health mainstream by the day, and harms the reputation of the profession of marriage and family therapy around the country.

Who will apologize for that?

Update: Apparently -- and to their great credit -- CAMFT will.

The short, successful relationship?

2009-06-26T14:03:00.000-07:00

In the Sex and the City movie, lead character Carrie Bradshaw narrates something to the effect of "Not all great love stories are novels. Some are short stories. But they are just as filled with love." Can a relationship with a short life span be properly labeled a success?

It's not just a philosophical question. Marriage and family therapists must regularly wrestle with the question of how "pro-marriage" or "pro-relationship" to be with their clients. We balance the ethical requirement, to respect clients' freedom to make their own decisions about their relationships, with the research base for our field, which shows that (1) people live happier, healthier, and wealthier lives when they stay married, and (2) a large majority of couples who stay together through difficult times report strong marital satisfaction five years later.

In my own practice, I am unabashedly pro-relationship. I tell clients who come in for Emotionally Focused Therapy that I will work to preserve and improve their relationship until they call me off, no matter how desperate the situation may seem. Final decisions on whether to stay together are always up to them, but they need to know what I believe and how I work -- another ethical responsibility, this one for informed consent.

In "A Vindication of Love," Christina Nehring argues that short, passionate relationships are no less noble, and may be more so, than the modern standard of a long-term, companionate marriage. Passionate relationships, even if brief, force one to live in the moment, to experience life in a deeper, more mindful way than is possible when planning out a long-term coexistence. Meghan O'Rourke at Slate was not convinced, and I tend to side with her.

Still, the topic leads me to think about the couples who come to me for therapy. Of course, many come in seeking to restore or strengthen their mutual sense of security and stability in the relationship, to ensure they can make it over the long term. But there are also those who seek exactly what Nehring vindicates: Immediacy, passion, feeling. These couples often have security in spades -- they have a strong commitment to each other (and, often, their children). What they want is to get out of that long-term mindset and back into the intense, spinning experience that, ironically, may have led to the conception of said children.

There's nothing wrong with either goal, of course. And as therapists, we're able to accommodate either, though I would readily admit therapy tends more toward the restoring-security side than the restoring-passion. (With notable exceptions.) But in either case, we're talking about therapeutic processes designed to maintain and strengthen a long-term relationship. I've never had a client openly tell me, "I would happily trade the security I feel now for a little excitement," possibly because they believe it sounds immature or hedonistic. Yet that precise willingness is often reflected in their behavior, through affairs or other kinds of risk-taking that may enliven the moment but damage the primary relationship. So therapy sometimes will seek to heighten excitement or intimacy without negatively impacting the couple's security -- see "Mating in Captivity" -- a trade that some couples find difficult if not impossible.

The careful balance between excitement and security is often a challenge for one person on his or her own, and becomes even more complicated when two people, whose needs change over time, are involved. A short relationship can be filled with love, and could be labeled a success if it meets the goals and desires of both partners -- of that I'm sure. Whether short, risky relationships are a worthwhile goal for therapy... that's a whole different question, and much harder to answer.

Finding MFT jobs

2009-06-17T14:43:00.000-07:00

The most common question I hear these days from marriage and family therapists (MFTs) is simple: "Where can I find a job as an MFT?"

The more pessimistic ones ask the same question, they just leave out the word "Where."

Even in the current economy, where budget constraints are pinching many public agencies, there are still literally thousands of jobs available, right now, for MFTs around the country. Here are some places to start finding them.

Professional associations. AAMFT and CAMFT (a California-based association independent of AAMFT) each have their own job-finder database. As of today (June 17, 2009), AAMFT's database lists 153 openings around the country -- admittedly not a great number, but better than none. CAMFT's database lists just 31 clinical jobs, but gets bonus points for a great directory of additional county- and hospital-based employment databases that MFTs will find useful. Both associations also offer events geared toward networking, and many job offers come out of the connections made at those events. They're worth attending.

Federal programs. USAjobs.gov is the best place to start looking for federally-funded jobs for MFTs. The trick here is to search wisely. Entering the keyword "family therapist" brings back 131 openings. However, broadening that to "mental health" leads to 1,750 jobs, many of which MFTs are well-qualified for. The database provided "suggested keywords" to help with your search in the past, but doesn't appear to now; it is good to search any related terms you can think of.

Bigger job-search sites. The usual suspects are not great help, but you may luck out. Searching specifically for "marriage and family therapist" jobs returned about 20 results each on Monster.com and Yahoo's HotJobs. CareerBuilder.com was a bit better, but still only offered about 50 positions nationwide. Again, you will find many jobs for which MFTs qualify if you search under broader terms. Also, on the plus side, these sites are frequently updated and older posts are quickly removed, so their offerings are always fairly fresh.

County and state agencies. There is great variety in what you will find online, based on where you live. But where they exist, county and state agency sites are often the best places to go. Check out the web site for your county and state Department of Mental Health (smaller counties or states may use different names).

Larger nonprofit organizations. Many nonprofits, particularly those that contract with counties to provide mental health services, don't post jobs beyond their own sites these days because they don't need to. Ask friends and colleagues who the big players are in your county, and start at their site. Case in point: San Diego's Community Research Foundation, which posted eight openings for clinicians in just one day yesterday. (Full disclosure: I did an internship at a CRF program several years ago.)

Old-fashioned networking. Personal connections remain the best way to get an interview. If you're looking, take business cards and resumes with you to every CE event or other professional gathering you attend, and make a point of introducing yourself around. Even those who are not hiring now may be hiring at some point in the future, so it's always to your benefit to build strong professional relationships.

If there are other good resources for MFTs I've left out, please feel free to post them in the comments.

CAMFT articles supporting traditional marriage: A detailed response

2009-06-14T07:49:00.000-07:00

CAMFT's latest issue of The Therapist claims to provide a somewhat balanced look at perspectives for and against same-sex marriage. The articles opposing same-sex marriage deserve a detailed response.

Full disclosure: I personally support same-sex marriage, and also believe a meaningful argument can be made against it, based primarily on the strange intertwining of marriage as both a religious and governmental institution. As you'll see below, I believe there are genuine ethical issues that will need clarification from mental health associations as gay marriage moves forward, to ensure that religious counselors are not discriminated against. In other words, there is a worthwhile discussion to be had here, on issues of ethics, law, and spirituality. Unfortunately, most of the articles presented in CAMFT's magazine feature irrelevant or inaccurate arguments, which is too bad. I've previously discussed why I believe the "debate" as CAMFT presents it is fundamentally flawed, but that was more of a broad-brush response. Below are more detailed responses to each article in the "Supporting Traditional Marriage" section.

An Inside Look at Gay Parenting

The lead article in the section details one woman's horrific childhood with a father who had horrible boundaries around his daughter and many male partners, but notably, stayed in a heterosexual marriage. Without a doubt, she genuinely suffered in her home, and I feel for her. Her plight, though, cannot be taken as an indictment of all gay parents any more than one case of horribly abusive, boundary-free heterosexual parenting can be taken as an indictment of all mother-father couplings. The author's experience was clearly very painful, but it is not the norm for any parents, gay or straight. It also does nothing to advance the marriage argument, given that her mother and father apparently remained married through the traumatic childhood she recounts.

Developments Ensuing Upon the Legal Recognition of Same-Sex Marriage in Massachusetts

To his credit, author Scott FitzGibbon gets his facts mostly right, and his article is well-referenced from relatively objective sources. I simply don't understand his alarmism.

As legalization of same-sex marriage in Massachusetts was arriving, Boston Public Schools developed a zero-tolerance policy for hate speech, including speech that would result in bias against gay or lesbian students. ("Bias" being a fairly vague term, the Boston policy has since been clarified to apply only to speech or action that results in a "hostile or discriminatory environment," a fairly important fact to be excluded from the article.) Zero-tolerance policies are generally bad policies, but this policy is neither especially egregious nor especially gay-friendly. Yes, teachers would be subject to discipline if their speech or actions resulted in a hostile environment against gay or lesbian students. They would be equally subject to discipline if their speech resulted in a hostile environment against straight students, or religious students. It's bad policy, but it's equal treatment.

The US District Court for Massachusetts has held that the state's schools have a responsibility to present students with materials that will foster respect for diversity. While the decision focused on same-sex families, its principles apply equally to religious diversity. FitzGibbon warns of the "absence of a reference to promoting critical thought," as though teaching respect for diversity somehow excludes critical thinking; again, consider the parallel with religious diversity. Schools should be teaching students to honor and respect classmates whose religious viewpoints differ from their own. School is not the place for students to be taught that one religious viewpoint is better than another. The ruling seems both appropriate and appropriately limited.

Apparently readers are supposed to be shocked and alarmed by a partial transcript of a teacher providing eighth-graders with medically accurate sex education. I wasn't. That kind of open discussion is exactly what reduces unwanted pregnancies and sexually transmitted disease. If it reduces stigma for gay students at the same time, all the better.

The author goes on to equate same-sex marriage with abortion:

"which, like same-sex marriage, was imposed by the courts against the wishes of many Americans, and in conflict with the religion and morality by which many citizens have been guided, and which has therefore been made available through school clinics without parental involvement."

This is inaccurate - schools don't provide abortions through school clinics, they typically don't even provide contraceptives; and parental notification/consent laws for abortion are the norm, not the exception - but more importantly, this is irrelevant. The only connections between abortion, comprehensive sex education, and gay marriage appear to be that the author doesn't like any of them.

The article concludes with its second reference to Parker v Hurley, a Massachusetts case where a parent sought to have his child excluded from (or at least that he have notification of) "any materials or discussions featuring sexual orientation, same-sex unions, or homosexuality." In other words, the parent wanted to remove his child from any and all activities that even acknowledged the existence of gay and lesbian people. The father's argument was rejected in court because it's ridiculous on its face. Should any child be kept out of, or a parent given pre-notification of, all classroom discussions or activities that acknowledge the existence of African-Americans? Or that acknowledge the existence of Baptists? Of course not. No matter how strong one's racial, sexual orientation, or religious bias, you can't avoid the existence of those who differ from you.

Treating Marriage as Discrimination Threatens Religious Counselors and Therapists

I know, like, and greatly respect co-author Jerry Harris, and I think there is a valid argument to be made about the possibility that some therapists could be unduly punished if non-discrimination clauses in ethical codes are improperly applied. Harris and coauthor William Duncan make their case using flawed case examples.

An Eastern Michigan student was supposedly dismissed from her counseling program because she refused to affirm a client's homosexuality. Contrary to what the article suggests, the student was not dismissed over her religious beliefs; the university would have honored the student's religious assertion if she were consistent with it. She was actually dismissed for violating the ACA ethical code (by selectively using her religious beliefs to justify refusing treatment to gay clients, but saying she would willingly treat those involved with abortion, child abuse, or murder), and then saying she didn't think the ethical code applied to her. "Who's the ACA to tell me what to do," a quote from the student, are magic words pretty much guaranteed to get anyone kicked out of their graduate program. A lawsuit is pending.

Separately, a Purdue student suffered "continually poor treatment" because of his opposition to same-sex marriage. This case is not cited and I could locate no other discussion of it in print or online. Even if true, every student has a right to their own opinions, but no right to expect that other students will agree with those opinions or like them; in this case, the only harm the student appeared to suffer was social ostracizing.

The authors state that

"Conflicts with religious liberties will be unavoidable when the state and professional governing bodies begin to endorse the idea that same-sex marriage or equivalent unions are mandated by principles of non-discrimination."

While conflicts may be inevitable, resolutions are certainly possible. APA and NASW have clearly endorsed the notion that refusing to allow same-sex couples to marry is discrimination, and they have strong subgroups of religiously-oriented professionals.

The ethical committees of each professional association do, certainly, need to provide greater clarity on when a therapist's refusal to treat clients based on the therapist's religious belief is discriminatory, and when it is simply proper clinical care reflective of the therapist's scope of competence. Taken at face value, I agree with Harris and Duncan that some of the therapists discussed here may have faced consequences they shouldn't have. But that ethical clarity can be provided, and we can move forward.

I see here a legitimate concern about the consequences of gay marriage, and how we can ensure that religious therapists will be able to continue to practice in accordance with their beliefs. But I believe that concern can be resolved to everyone's satisfaction, and I'm not convinced that it amounts to an argument against the existence of gay marriage.

Gay Marriage and Injustice

In case we needed a reminder that The Therapist is not a scholarly publication, here we have an article that mentions lots of studies while giving full references for exactly none of them. Author Walter Schumm starts by moving the target (emphasis in original):

"The argument for gay marriage is not about marriage but about benefits... The question is whether they [gay and lesbian couples] should be entitled to the same benefits granted to married mixed-gender couples."

If that were the question, it could be settled with civil unions. Gay and lesbian couples want marriage.

After making a slew of arguments completely irrelevant to what he says is the question at hand (at least one of which, the notion that gay parents are more likely to have gay children, has been thoroughly and repeatedly debunked), Schumm settles on the notion that same-sex couples do not have or raise children as often as opposite-sex couples, so they do not provide the same benefit to society and should not be supported in the same manner.

Two problems here. One, it's an equally valid argument for keeping the elderly or the infertile from marrying, and I don't see Schumm or anyone else opposed to gay marriage encouraging those additional restrictions. Two, for many gay and lesbian couples, they don't raise children because they're not allowed to, which presents a beautifully circular argument: Because same-sex couples are not given equal benefits under the law, they can not raise children as often as heterosexual couples. Because same-sex couples do not raise children as often as heterosexual couples, they should not be given equal benefits under the law. This is not an argument that makes enough sense to be debated.

Same-Sex Marriage: Not in the Best Interest of Children

"Proponents of same-sex marriage believe love is all children really need." This is fundamentally not true, and another logical fallacy. At least this article aims to look scientific, with dozens of references. However, the scientific community is largely in agreement that gay parenting is not harmful to children, and many in the community believe that allowing gay parents to marry will improve family stability and child functioning, not undermine it. For much more thorough, and more scientific, summaries of the research than what this article contains, just flip to the "Supporting Same-Sex Marriage" section of the same magazine. Or, see the following: ACLU summary (starts on page 24, runs for 50 pages) | APA 2005 research summary | APA policy statements | AAMFT consumer update (brief) | AAMFT task force full report (members only).

Among the few reliable research findings presented here and in Schumm's article, many of the comparisons are not related to the discussion at hand, a point well-made at the Independent Gay Forum:

"[W]hether or not gay marriage is allowed, children will continue to be raised by gay parents. The only question is, Will these children be raised in homes that may enjoy the protections and benefits of marriage? If it's better for children to be raised by a married opposite-sex couple than by an unmarried opposite-sex couple, it would surely be better for children to be raised by a married same-sex couple than by an unmarried same-sex couple. That's the relevant comparison, not the comparison of married straight couples to gay couples. If it's really concern for children that's motivating opponents of gay marriage, they ought to rethink their conclusion. They should be pounding the table for gay marriage."

Proposition 8 and the Attack on the Religious

Author Austin Nimocks starts by asserting that no matter what one's religious beliefs, he or she is accorded the right to "hold those beliefs and order your life accordingly." No argument there. He goes on to cite an example of someone forced from his role because his views opposing gay marriage became a distraction -- a phenomenon that cuts both ways, though I tend to agree that it's unfair on either end.

Nimocks goes on to cite the case of a marriage counselor in Georgia fired from her position for refusing to counsel a same-sex couple(1); it's also one of the cases Harris and Duncan cite, and I would respond the same way here: There is a genuine ethical issue that professional associations will need to resolve in ensuring they do not simply exchange one form of discrimination (against same-sex clients) for another (against religious therapists). It is resolvable, and doesn't advance or detract from arguments around gay marriage.

Most of the article, in fact, isn't relevant to the marriage argument; it's just fear-mongering. Gay marriage, he asserts, will lead religious therapists to be fired from their jobs, perhaps sued by clients. Yet of all the case examples in both this and the Harris & Duncan article, only one of them took place in a state where same-sex marriage was legal. So it's unclear how these articles advance the argument against such legalization.

Ultimately, religious leaders of various faiths in Massachusetts have said that the legalization of gay marriage has not impacted their religious freedom.

Why Marriage Matters

It's about the children, writes William Jeynes. He warns

"Same-sex marriage will mean the law, the government, and and the public schools of California will educate the next generation that our older marriage tradition was based on bigotry and was discriminatory."

It was discriminatory, and we already teach precisely that: Our older marriage tradition was based on bigotry and discrimination. Ending race-based restrictions on marriage did not destroy the institution of marriage or weaken families. Instead, after Loving v Virginia, interracial couples who would not have enjoyed the institutional support of marriage were able to receive it, and I know of no one who in restrospect believes that Supreme Court ruling was a bad one.

Ironically, Jeynes goes on to make an argument that works better as an argument in favor of gay marriage than one in opposition: "Marriage, as it has existed through countless centuries, has stood as an institutional act of compassion that protects the present and future welfare of children and promotes physical and mental health." I agree wholeheartedly. If you want to protect the welfare of thousands of children who now lack certain protections, let their gay parents get married.

Excerpts from the Amicus Brief of Iowa

This section from an amicus ("friend of the court") brief submitted by about a dozen academics is straightforward enough, discussing the historical context of marriage as a union designed around procreation. This argument is demonstrably false, and more importantly: it lost. The Iowa Supreme Court decision takes apart the research cited in the amicus brief in far greater detail than I could here, so I'll simply direct you there.

---

So we're left with a section of articles that distort facts, make irrelevant arguments, and would be quickly rejected by any kind of scholarly journal. Yet these articles are given equal time and weight with peer-reviewed, scientific articles supporting gay marriage that are copied from academic journals, as the though the two somehow have equal validity (or, on a more basic level, quality). A meaningful discussion could have taken place here, with religious articles as a counterweight to the scientific ones; but that isn't what is presented. Too bad. Genuinely written articles on the difficulties religious therapists have when confronted by a situation where they need to balance their empathy with their religion -- those would have been worth reading.

Footnote:

(1) There is some source material online in both the Eastern Michigan case and the Georgia case. Eastern Michigan: News story 1 | News story 2 | Transcript of formal hearing | Letter dismissing student from program | Lawsuit. Georgia: Initial legal complaint | News story

On same-sex marriage, CAMFT stumbles along

2009-06-11T17:14:00.000-07:00

In response to the controversy over its steadfast and solitary refusal to even make a statement about same-sex marriage, CAMFT dedicated its May/June issue of its magazine, The Therapist, to discussion of the topic. In the process they got some things right, and others wrong. Credit, and blame, where due:

Right: On social issues, CAMFT has never stood for anything. In his column, board president Patrick Healy reminds readers that CAMFT has never taken a stand on any social issue. When called upon by groups of members to oppose the Vietnam War, stand up for women's rights, or move a conference from a hotel where labor abuses were taking place, CAMFT has a long history of inaction. Duly noted, and not exactly a badge of honor.

Wrong: If CAMFT takes a stand on gay marriage, it must take a stand on everything. As Healy puts it, CAMFT is not a social justice organization. He goes on with lazy "slippery slope" rhetoric: "If CAMFT ever gets into social justice work, I'd like to ask it to take up the charge" on a variety of issues, Healy says. But CAMFT is hardly locked in a quagmire if it takes on the topic; most mental health organizations have clear policies for determining what social issues are worthy of their attention, and have been able to take a stand on gay marriage (and limited numbers of other issues) without falling off of some social-justice cliff and losing sight of their purpose.

Right: CAMFT does not want to risk alienating a portion of their membership. I genuinely credit Healy for being straightforward in saying so: "Taking a stand would alienate a percentage of CAMFT members." The logic, of course, is easy to poke holes through: failing to take a stand alienates a portion of CAMFT members. The organization is making an active choice in whom it chooses to alienate.

Wrong: The "pro" and "con" arguments presented in the magazine are equally valid and deserve equal space. The "Professional Exchange" section consists of one batch of articles supporting same-sex marriage, and another opposing it, on very different grounds. The "pro" articles are mostly copied from academic journals, and show just how clear the scientific evidence is: same-sex parents raise their children just as effectively as heterosexual parents, and same-sex couples and their children suffer due to marriage discrimination. The "con" articles are largely made up of arguments that are inaccurate or irrelevant (much more on that to come in a separate post).

While I am solidly on the pro-gay-marriage side, I do believe there is a real, cogent argument to be made against same-sex marriage based on how marriage intertwines with religious principles. I also believe that religious therapists have a genuine struggle to balance religious belief with appropriate care, and that all mental health professions need to find ways to affirm same-sex couples without discriminating against clients or therapists based on religion. This section is largely not that kind of discussion, though, which is disappointing. If anything, it seems to be a disservice and an insult to those who would have valuable and intelligent points to make in opposing same-sex marriage.

Wrong (maybe): This collection of articles will settle the angry mob. In spite of the headline "Tackling the Issues of Same-Sex Marriage" on the magazine's cover, presentation of a variety of viewpoints while disavowing all of them does not constitute "tackling" of anything. If CAMFT really wanted to "tackle" the issues, it would appoint a committee to examine the research and solicit member comments, and then make a policy recommendation (that the full board would hopefully endorse). This selection of articles moves no closer to such a resolution. I find it hard to believe that those therapists who have been dissatisfied with CAMFT up to now will find themselves appeased.

Why MFTs struggle to influence public policy

2009-06-08T11:16:00.000-07:00

As marriage and family therapists, we have a vast body of knowledge supporting our work with families and communities. Many of the pinciples and interventions from this body of knowledge could be utilized in public policy, to great positive effect. As two examples, family breakdown could be reduced, and juvenile crime recidivism decreased, both in ways that actually save taxpayers money. Politicians of all parties should be chomping at the bit for such policies.

Except that they don't. And the April Family Relations journal helps us to understand why not.

In "The voice of experience: How social scientists communicate family research to policymakers," authors Bettina Friese and Karen Bogenschneider discuss why family research is not as utilized as it could be in policy, carefully avoiding blame and focusing instead on those practices that have been shown to work -- in the rare instances in which they've been used. For example, the seemingly obvious step of taking "the initiative to contact policymakers or policy intermediaries" had been taken by only one of the 49 participants in the study. And these were 49 leaders in applying research to policy, who had actually taken part in Wisconsin's "Family Impact Seminars" for legislators and their aides.

So, just as MFTs could gripe that policymakers are not putting our work into policy, policymakers could just as easily complain that we're not reaching out to them with anything useful.

The other recommendations show similarly pragmatic ways MFTs can improve information delivery to make it more useful (and influential). "Conceptualize policy work... as developing relationships" rather than providing one-shot informational pieces seems to be good advice, as does "Communicate research findings in ways that meet policymakers' information needs." On the latter point, if researchers don't help, legislators may rightly feel the need to do it themselves. This publication, essentially a content analysis of abstinence programs, seems like it ought to have been done by a non-governmental agency.

The article's final recommendation, "Be patient and self-rewarding in defining success," shows most starkly the difficulty educators and researchers have in gaining support from their universities to assist in policy discussions:

According to seven researchers from land-grant universities that are expected to translate research for public consumption, policy work is time consuming and too often considered "an extracurricular activity."

In spite of the barriers, there is room for optimism here. MFTs can and do influence public policy, and professional associations AAMFT and NCFR have made infusing research into policy discussions a key element of their work. And these associations are generally eager to enlist willing MFTs in the effort, especially at the state and local level. All that's needed is the energy and interest to be part of the discussion.

Cohabitation not so harmful to marriage, new studies show

2009-05-21T17:40:00.000-07:00

A trio of studies in the May Journal of Marriage and Family may be leading indicators of a fundamental shift in how cohabitation impacts eventual marriage. It may not be as harmful as previously thought.

It has been well-established for years that cohabitation before marriage increases eventual chances of divorce. (A good-albeit-old summary of this research, including possible explanations, is here.) This has been such a clear and consistent finding, in fact, that its opposite is featured in my 2008 article as a "myth about marriage" that research has convincingly debunked.

Now, all that may be changing. A study of marriages in Australia finds that the gap between cohabiting couples and non-cohabitors in later risk of divorce has been shrinking as cohabitation has become more common. The correlation may even have flipped. In one of the study's predictive models, for couples married since about 1987, non-cohabitors have been more likely to eventually separate than those who cohabited prior to marriage. (In the study's other predictive model, the lines have not yet crossed, but since the late 1990s there has been essentially no difference between cohabitors and non-cohabitors in risk of separation.)

There's more. A separate national (US) study examining marital quality rather than simply separation looked at nearly 4,000 women born between 1957 and 1965. The authors found that

The negative correlation between premarital cohabitation and marital quality is largely driven by the nonmarital parents in the cohabiting population. [...] Furthermore, marital quality is "locked in" at the start of marriage, with lower quality marriages neither catching up nor deteriorating more rapidly than others. (p. 313, emphasis mine)

In order to put meaning to these numbers, it is important to understand how couples today are looking at marriage and cohabitation. That's exactly the purpose of a third study in the journal, titled "The Social Construction of Marital Commitment." The researcher interviewed 75 women and men between ages 28 and 35, most in New York state. Based on their own descriptions, participants' commitment to marriage was made of two parts: How they saw marriage as a "life style option" that had value compared with other options like cohabitation, and how (or whether) they saw themselves actually achieving married status. Speaking to the first element (value), most of those who were not in a relationship "were reluctant to assign a value to marital commitment that distinguished it from other forms of attachment" (p. 324, emphasis mine). Even among those who did place value on marriage, there appeared to be varying degrees of belief that the kind of marriage they envisioned was actually achievable.

Together, these three articles show in stark relief just how out-of-date our knowledge about marriage could be. Mind you, it's not that we haven't been doing the work. Rather, it appears that generational shifts in both attitudes and behavior toward marriage have been occurring much more rapidly than we've been able to effectively monitor. I wonder how many more of those supposed myths about marriage may be shifting to truth, and how long it would take for those shifts to be detected.