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.

Blogging the AAMFT Conference: Sunday

The AAMFT Annual Conference wrapped up Sunday morning, as the last die-hards snuck in one last 3-hour workshop before drifting up to the Sacramento airport and back home. I was a presenter on Sunday morning, but only if you use the word “presenter” loosely; I led a panel discussion on licensing exams.

Before you go into the automatic response (which is, I believe, “zzzzzzz”), you should know there was one significant piece of news to come out of it: California’s Board of Behavioral Sciences and the Association of Marital and Family Therapy Regulatory Boards, who develop the California and National MFT Exams respectively, have agreed to collaborate on their next occupational analyses. It’s a small step but a significant one, as it will at least allow for an apples-to-apples comparison of the practice of MFT in California versus around the rest of the country. That kind of comparison would be necessary in any discussion of California eventually moving toward use of the National MFT Exam — something I believe in very strongly.

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As is the case every year, I leave the conference energized, with many new research ideas, new potential collaborators, and new respect for the amazing work taking place in our field. I also leave Sacramento with renewed appreciation for just how clinically strong our Alliant students are and will be; it wasn’t at all unusual to see the best questions in any workshop — and often the best answers as well — coming from people with orange “Alliant” stickers on their badges. Great work, everyone. See you in Atlanta next September.

Blogging the AAMFT Conference: Saturday

Susan Johnson stole the show with her plenary presentation at the AAMFT Annual Conference in Sacramento today. Presenting without Powerpoint slides was itself refreshing, but she said several things in a far more eloquent manner than anyone else has this weekend. I’m paraphrasing, but here were a couple of my favorites:

  • Therapy needs higher goals than simply reducing conflict. We get better every day at actually creating new love and bonding.
  • Emotions have an exquisite logic to them that is not to be ignored or dismissed. For EFT or any other kind of therapy, clients should not expect that they need to leave their intellect at the door.
  • Connection with a partner soothes the brain. MRI studies show that an expectancy of shock is mediated when in physical contact with a partner.
  • When it comes to sex, research is clear: Practice *and* emotional connection make perfect.

The workshops I attended today were good informationally, but neither was put on by especially dynamic presenters. I learned about marital satisfaction instruments and online education, both of which are eminently practical — one of the things I like most about the conference.

The evening presentation by Dorothy Becvar was a nice review of the history of the field in terms of its concepts and contributions to mental health. A good (and brief) final plenary to a very good conference. I’ve heard that the other workshops were greatly varied this year in terms of quality, but that those that were good were incredibly good. The conference concludes tomorrow with a set of 3-hour workshops, including one I’ll be moderating on the licensing exam development process. More tomorrow.

Blogging the AAMFT Conference: Thursday/Friday

Today was the first full day of the AAMFT Annual Conference, which is in my former hometown of Sacramento. It’s been great catching up with old friends, colleagues, and students — this event has become as much a reunion for me as an educational experience. Still, I’ve learned a lot. Here’s what I’ve learned last night and today:

  • We’ve come a long way. The opening plenary on Thursday night was an appreciation of the history of our field, and a celebration of finally accomplishing licensure in all 50 states. Bruce Kuehl did a great job with it, and I may be adding clips from this to the MFT Theories course next year.
  • I need to start a Facebook group. I’ll call it “MFTers for Changing MFTers for Change.” But then a subgroup would probably spring up to try to change my group, and I don’t want that kind of trouble.
  • Family systems and psychoanalytic principles are not mutually exclusive. Okay, to be fair I already knew that. But Richard Scwartz’s presentation of Internal Family Systems made me believe this more strongly than I had before.
  • COAMFTE accreditation matters. I already knew this too, but now I have more evidence to back it up. Jeff Larson was kind enough to fill in for Russ Crane, and Jeff joined Mary Moline and I in presenting a workshop on the things that set COAMFTE programs apart. Jeff handled curriculum, pointing out that MFTs are required by licensure laws to get far more education and experience in family therapy than any other profession. Mary took on public mental health, reviewing how the COAMFTE programs in California and around the country are uniquely positioned to integrate changes in public mental health approaches like the recovery orientation. And I took on licensure, pointing out that graduates of COAMFTE-accredited programs get further, faster in the licensure process and are more likely to pass their exams than graduates of non-COAMFTE programs.

Overall, the AAMFT Annual Conference has again earned its spot as the most valuable and rewarding continuing education event I attend during the year. More tomorrow.