What’s going on with California’s MFT Clinical Exam? [Updated]

California flagIt is certainly debatable what an ideal pass rate for licensing exams should be. If the pass rate is high, that means almost everyone gets through. Then the tests don’t serve a meaningful function. (That’s pretty much the status quo.) If the pass rate is low, it raises questions about the validity of the exam, given how much time most examinees spend preparing for it. But what makes a pass rate too high or too low? Given that the exams don’t do much of anything anyway, it’s hard to say for sure.

But it does raise eyebrows when pass rates for a single exam fall off a cliff, as seems to have happened for California MFTs over the past year. Here’s the data provided by the state’s Board of Behavioral Sciences for first-time test-takers on the state’s clinical exams:

Counselors had a rough go of it in the third quarter of 2016, but that could simply be random noise. The LPCC license is still fairly new in California, and so very few people actually take the clinical exam. There were about 20 first-time test-takers per quarter shown here. For MFTs, however, the sample size is much larger, with several hundred first-time test-takers each quarter since the new exam began in early 2016.

It is normal for tests to fluctuate a bit in difficulty with each test cycle, but on the MFT Clinical Exam, the passing score is supposed to fluctuate to account for that. Tougher exams have lower score requirements to pass. It doesn’t stand to reason that the examinee pool has changed dramatically over a single year. So how is it that the pass rate has dropped from nine out of 10 to just more than half?

I’ve reached out to the BBS for comment, and will update this post when I hear back. Notably, California is the one state in the country that doesn’t use the National MFT Exam. It uses a state-based exam instead.

Update, May 8, 2 pm: BBS Assistant Executive Officer Steve Sodergren provided this explanation from their Exam Development office (emphasis mine):

In a typical examination cycle, the candidate distribution is comprised of the following three groups: (1) first-time test takers who achieve a passing score, (2) first-time test takers who do not achieve a passing score, and (3) repeat test takers. When the LMFTCE exam went into effect in January of 2016, the candidate distribution was atypical. All candidates who sat for that examination had taken and passed the Standard Written examination, and many had also taken the Clinical Vignette exam. It appears the distribution remained atypical for the next few subsequent administrations. Due to this anomalous situation, a higher passing rate for these administrations was expected to be seen than those for a typical distribution.

That would be a sensible explanation if the pass rate for first-time test-takers in 2016Q1 were unreasonably low, but it doesn’t make a lot of sense for the pass rate to be unusually high. Repeat test-takers typically pass an exam at a lower rate than those taking an exam for the first time. As those repeat test-takers from the (now outdated) WCV became a lower and lower proportion of what the BBS data would call “first-time” examinees, the pass rate for first-time test-takers should come up, not down. I’ll gather more info and post another update if warranted.

14 thoughts on “What’s going on with California’s MFT Clinical Exam? [Updated]

  1. Can someone please share with me the passing score last year quarter 3 in 2016? I took the exam and missed by one question. I know currently it is 98/150 but does anyone know what it was back then? I wrote BBS 2x”s but no answer. I’ll be sitting for the exam next week and it would help for me to know. Thanks!

  2. The reason the pass rate is so low is because the “correct” answers are so subjective and sometimes flat out wrong. One question asked when confidentially can be broken. The rational given for the “wrong” answer was “A minor inflicting self-harm may or may not be a reason to break confidentiality. What does that mean? If it “May” then is that not a reason? That answer was wrong when by their own rational, it was right. On several questions the rational’s pointed out that all the points were correct but in their “opinion” the other answer was the “best answer” as if somehow overnight psychology became a hard-science. Perhaps they ought to give 3 wrong answers and 1 right one instead of 2 or 3 right answers and they decide which one is better without considering other rationals by the test taker. It’s like saying on “their” diagnosis is the correct one….because it’s theirs…… so wrong.

    • There’s a lot to dislike about licensing exams, but this argument falls short on a couple of levels. First, the exam is not subjective. Every item is keyed to a common resource text in the field, otherwise it wouldn’t be legally defensible. And every examinee is held to the same standard. So you can argue that the questions are unclear, debatable, or poorly written — each of which has some truth to it — but you can’t successfully argue that it’s subjective. The old oral exams, by holding examinees to different standards based on the opinions of the particular examiners, were subjective. Under the current process, everyone is held to the same standard.

      As to the example you gave, that sounds like it came from a test-prep process, and not from the BBS itself. The BBS doesn’t release rationales for correct answers. (I’ve been pushing lately just to get some retired questions released publicly.) Even so, based on what you have here, I’m in agreement with that rationale. You can’t assume facts not in evidence, as a lawyer might say, on an exam question. You work just with what’s in front of you. So the knowledge that a minor is self-injuring, in and of itself, is not sufficient grounds to breach confidentiality. A lot would depend on the type, nature, and severity of the self-injury. Without that information, you don’t have enough to justify a breach. So a response choice that includes breaking confidentiality isn’t going to be correct.

      Listen, licensing exams suck. I’ll keep actively pushing for reforms of the process. But framing them in the way you do makes them into something that can’t be understood and can’t be beaten. They’re just not that nefarious.

  3. I agree with the first commenter. It is confounding that the BBS doesn’t predicate many of their licensure requirements based on hard data. The 3000 hour requirement? After 100 hours of practice, therapists do not improve in achieving better clinical outcomes. 3000 hours of training is arbitrary; do they simply FEEL that 3000 hours is a good number? I don’t want any regulatory body creating policies based on emotions rather than data. From where did that number originate? Even though I passed the MFT clinical exam in November of 2016, the theories we were tested on were so outdated (reality therapy)? The cost of the study materials and the exam fees were very prohibitive for an unpaid intern – yet another exclusionary practice making it difficult for those of us that are in a lower socio-economic class struggle to enter the field. So many unanswered questions, even after writing to the BBS to receive justification for these policies.

  4. As someone who was heavily affected by the change in the BBS testing process in late 2015/2016, my experience pointed to an ill-prepared, out-of-touch and horribly out-of-date process of test design and testing process. I am an LCSW (as of Feb 2016) who received her MSW in 1988 (though had years of clinical practice under my belt). Coming back to test for the exam after 25 years meant that I had to relearn almost everything in order to take the test. That meant that I was preparing for the test with the most popular prep courses, AATBS, TDC, Grossman, which honestly, were highly in conflict from each other in content, in their styles of questioning and answers, including very conflicting answers and reasoning. The testing questions in the booklet from the BBS were a poor example of what I would experience.

    When I heard that they were putting a clinical test in place for MFT and counselors, I was stunned. The CA LCSW clinical test that I took in late 2015 was filled with ambiguous questions, answers based on out-of-date clinical knowledge, an emphasis on treatment modalities and approaches that are uncommon in actual treatment. Even the test coaching approach to answering based on “what would the Board want you to know, not what you would actually do” did not produce successful answers. Plus, what the hell is the Board doing designing questions that put clinicians in this unethical position of having to go against sound clinical practice to answer based on the BBS’ need to ask obscure and or highly subjective questions? I could not believe that they asked a question about a highly specific foster care legal procedure that would be so rare and only known by those going to an actual court proceeding with foster child. A question about sexual behavior was based on 25 year old mythology. I failed the test by a ridiculous number, only to take the NASW clinical exam (begun in 2016) and find a far less biased, more subjective, more current and appropriately-difficult but passable test (6 months, hundreds of hours of extra internship and thousands of dollars of supervision later). I also encountered hundreds more dollars in a prep course and test banks to prepare. These tests on clinical skills do not test effectively test clinical skills, let’s be clear on this. These tests came as a result of the BBS’ need to reduce the expenses of human clinical expertise panels where the clinical panelists would pose questions to applicants such as “How would you approach this client situation……..?” Testing clinical expertise is a very difficult metric to assess. If the schools that educate each of these therapists focused on making sure their students are readied as clinical practitioners, the BBS would not have to be screening for such basic clinical skills and could concentrate on ethics, law and consumer protection.

    The national exam boards – NASW, AAMFT, NBCC have been doing these tests for decades. They have the experience and the expertise in question design. These national boards are designed to cover knowledge shared throughout the country and allow for a continuity of clinical practice expectations throughout the US. I heard that the reason that CA BBS went to a CA-specific test was because the BBS felt that the national test was not rigorous enough. If that was true, it was 20 years ago. Many people do not know that the LCSW national test is the ultimate test of 4 possible tests that a social worker can take for increasingly higher license levels. California LCSW’s are being asked to take a test that most social workers around the country will never need to take. The national LCSW test is to license those who have years of experience and are already master social workers and supervisors.

    Ben, you are so passionate about how the BBS operates and ensuring that the testing process be as fair and objective as it can be. I appreciate that you are asking the difficult questions which force the BBS to be accountable to the tens of thousands of intern applicants and the public at large.

  5. Just want to note that I disagree with the premise that all exams require some people to fail, or they don’t serve a meaningful function. There’s research showing that instead everyone can be taught to learn, rather than assuming a bell curve. It also seems injust to have people go through an expensive education, an extended often multi-year process of internship that can be extremely low paid or unpaid, and then fail at the end of that process. That’s a lot of risk for a relatively low paying field. I’m curious if the exam is confusing – as some have expressed – or if people don’t know the information on the exam. Has it ever been explored to take a pre-exam earlier in the process?

  6. I took the orals and written in 1993. If memory serves me correctly pass rates were also very low at that time

  7. i took it and failed the clinical exam. it was crazy . it had nothing to do with my profession nor keeping the public safe. the questions made no sense at all. i had prepped using a test prep service and had don well , and those questions made sense. I have written to the BBS who said they forwarded them to the office that makes the test but nothing came back. I know people who have given up after spending $100,000 and 8 years of their life to take the test but failed several times. In a state so in need of mental health professionals it is sad that this “test” is the last and horrible but useless hurdle.

  8. If my memory serves me correctly, it was about 35% for the Oral Exam and 45% for the Written Exam in 2012 when I took it. What is the pass rate for the National Exam?

      • Ah. I don’t have data going back that far, but it would not surprise me if low pass rates were among the reasons why the oral exam was phased out.

    • The oral exam was phased out around 2003. For the Standard Written Exam and Written Clinical Vignette Exam — the two exams that California MFTs took prior to the 2016 restructure — pass rates for first-time test-takers typically were around 80%. There was some fluctuation in those numbers, too, though up to 2016 the data was reported in six-month chunks rather than quarterly.

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