I’m at the California Board of Behavioral Sciences (BBS) meeting today in Orange County, with Robin Andersen from Prelicensed. The BBS has returned to two issues I’ve raised here previously: The alarmingly low pass rate on the California MFT Clinical Exam, and the issue of sites charging trainees to work there.
Streamlining licensure. Banning reparative therapy for minors. Fixing problems in child abuse reporting. Changing “interns” to “associates.” Saving Psychotherapy.
I’ve spent years now fighting for major changes in the world of mental health care, and winning. Many of the changes I’ve played a role in were ones that I was told would be impossible.
Today we launch Ben Caldwell Labs, the most important project of my career. The change I’m fighting for this time involves you.
Student loan debt has been a regular topic here, as it should be. Mental health professionals need to have graduate degrees, which often means taking on significant debt. The American Psychological Association reports that PsyD students in psychology now graduate with a median of $200,000 in student debt just from their graduate studies. The federal government offers loan forgiveness for those who work in government and nonprofit organizations, through its Public Service Loan Forgiveness program.
Recently, there’s been some concern over the fate of that program. Therapists and counselors currently working in nonprofit settings wonder whether they will in fact be eligible — or whether the program will still exist — by the time they complete 10 years of service. But their concern is (at least so far) not supported by what’s actually been happening.
[Originally published May 2014.] Last week in Isla Vista, California, Elliot Rodger killed six people before taking his own life. His family says he was seeing multiple therapists. Meanwhile, in the California legislature, discussion of a bill that would mandate additional suicide prevention training for therapists has focused on research showing that more than 30% of those who commit suicide had seen a mental health professional within the past year. Why can’t therapists do more to stop violence among our own clients?
I just took the California MFT Clinical Exam and the National MFT Exam within a month of each other. When scheduling both of these exams, my hope was that I could study once, and then ace both. Here, I’ll outline the similarities and differences I noticed between the two exams.
In every state, and for every psychotherapist license, there is a supervised experience requirement. Those requirements differ a bit from state to state and between license types, but they all hover around the same place: two years of full-time experience or the equivalent, typically operationalized as 3,000 hours. Where did that standard come from, and how has it changed over time? You may be surprised.
It’s nearly 100 years old.
The US Senate may take action this week on the Graham-Cassidy health care bill, a last-ditch effort by Senate Republicans to repeal and replace the Affordable Care Act. If Graham-Cassidy becomes law, the consequences for US mental health providers and their clients would be disastrous.
The nonpartisan Congressional Budget Office will not score the bill before a September 30 deadline for Senators to vote on it. But estimates suggest that under the bill, at least 16 million Americans would lose health insurance entirely after 10 years, given the bill’s similarity to prior Republican health care bills. This would leave millions paying out of pocket for mental health care that is currently covered by insurance.
I was working in a residential treatment center for teens. It was a typical mid-week day, and I was supervising “school time,” a period where clients are able to work on their treatment assignments and homework from their schools back home. Often during this hour, the primary therapists would pull the clients for individual sessions. I happened to know that today was the day that Nicole* was going to be given her diagnosis of depression, and I was prepared to help her process her emotions should she need coaching after her return from session. Sure enough, Nicole returned from her therapist’s office with a solemn look on her face. When she sat down away from her peers, I walked over to her and asked, “How did it go?”
She let out a sigh, “Well, I found out my diagnosis.”
I nodded. “I see. What’s that like for you?”
“I guess it’s better to know what’s going on and have an explanation for everything. At least it’s not like I have cancer!”
That comment gave me pause. I thought: But I have cancer.
App-based therapy platforms may well represent the next evolution of psychotherapy practice. I praised Talkspace a few years ago for offering access to mental health care for many who otherwise would never find their way to a therapist’s office. But the platforms — Talkspace, Betterhelp, and the like — have run into controversy over their confidentiality policies. Therapists using these apps may have little to no ready access to the client’s full name, address, or other information necessary in an emergency.
I’m a young therapist. I started my graduate program at 23 years old and finished at 25. When I first started seeing clients in a school setting, I was 24, and their parents were often in their 40s or 50s.
I also have a young face. When people guess my age, I get anywhere between 17 and 23. I’ve been told that this is a good attribute to have, yet I am not yet seeing the benefits in my career. Several of my clients were taken aback when they first met me. Addressing my age and experience has become a norm, and I’ve accumulated a handful of recited professional responses when this occurs.