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

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

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

Images from the first Gulf War. Visit www.va.gov for complete information.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

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.

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.

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.