A few years ago, I wrote about income share agreements. ISAs are a novel way of financing higher education. Under this model, rather than paying tuition, a student agrees to pay a percentage of their future earnings back to whatever entity agrees to finance the person’s education now. It’s now called deferred tuition, and it’s still a bad idea.
The first licensing board meeting that I attended was in Sacramento. I did not live locally, so I had to travel to attend the meeting. I can remember well that trip and all of the expectations that I had. Basically all I knew about the California Board of Behavioral Sciences (BBS) was what I had heard from professors while in my master’s program, which was that the BBS was some ultimate authority that was to be revered and respected.
Because of what I had been told, I had honestly expected the meeting to be at some lavish location with lots of amenities. I expected the board members to be sitting on a platform, similar to a judge in a court, to highlight their authority. I had expected there to be structured, pre-arranged seating for those in advocacy positions. (I was attending as part of my advocacy role within the California Division of AAMFT.) Arriving early seemed critical, as I had expected there to be a relatively large crowd of attendees present.
None of those expectations came to pass.
The mental health professions have long recognized that with our positions and our expertise comes a great deal of responsibility. In exchange for our professional status and the trust we are given to work with vulnerable people in private, we agree to act not just on behalf of our clients, but also on behalf of the larger communities who grant us that very trust. This means maintaining awareness of the laws and policies that impact our clients and communities, and working to change those policies that are not in the community’s best interest.
While each professional organization phrases this obligation differently, they agree that it is part of being a counselor or therapist. Simply put, you are expected to use your specialized knowledge and training to benefit the larger community. It is part of holding the title of a mental health professional.
Ben recently published an article on the shortage of therapists in California. He discussed the “supply-demand disconnect” and why it’s so difficult to meet the needs of clients across the state. Toward the end of the article, he remarked that due to this shortage, “more of our functions will be turned over to substance abuse counselors, peer counselors, and other professionals and para-professionals.”
What did he mean by that? How can therapists possibly be replaced by individuals who haven’t earned a master’s degree, aren’t registered with the Board of Behavioral Sciences, and aren’t supervised by a qualified mental health professional? Unfortunately, I can cite examples from my own personal experiences in the workforce that support Ben’s claim.
ACA, AAMFT, and CAMFT continue to work with and others in Washington to get LPCs and LMFTs included as eligible providers in Medicare. Bills pending before both the House and Senate would do it. And that change would be beneficial for consumers and taxpayers alike.
Barry Duncan has an article in the current Psychotherapy Networker asking, “Why would anybody become a therapist?” The job offers low pay compared to other jobs with similar training requirements. Workers in community mental health are often stretched beyond the breaking point. And as we’ve covered here regularly, employer abuses of therapists are unfortunately common. When even a single therapist pushes back against exploitation, it makes a real difference. But that doesn’t happen very often.
Duncan’s article offers some interesting overlaps with our past coverage here. It can explain fairly well why even the best therapists can be easy targets for exploitation at work.
Look, I’m not here to defend the BBS (California’s Board of Behavioral Sciences) or any other licensing board. They’re not your friend. They require deeply flawed exams that even they know don’t work. Their disciplinary guidelines, especially around substance use issues, are unreasonably punitive. They are notoriously unresponsive. There are a lot of problems there. But it’s also true that most complaints about the BBS are based on flat-out falsehoods.
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 2009 Family Relations journal helps us to understand why not.
Casey Meinster is the Director of Evidence Based Practices at Hathaway-Sycamores Child and Family Services, a major mental health services provider in Los Angeles. In that role, she wrangles a lot of information. But one piece of information I learned from her changed how I think about the importance of measurement in psychotherapy.
Hathway-Sycamores serves thousands of clients a year through more than a dozen programs. They fund those programs through a variety of sources, including government contracts, grants, and other sources. And it is now the case that every single program they run now has to produce outcome data on its clients. Their payors demand it.
California suffers from a severe and worsening mental health workforce shortage. In fact, much of the US is in the same boat. There simply aren’t enough qualified mental health professionals to meet our country’s needs.
At the same time, therapists in private practice often complain about their local markets being saturated. There are so many therapists in some places, it seems, that it’s hard to get a career off the ground.
As it turns out, there’s truth to both of these perspectives.