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

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

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

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

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?

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

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?

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

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

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.

California LPCC law passes; should MFTs dually license?

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.