New documentary tackles the divorce industry

DivorceCorp opens in January. It looks great — with one little caveat.

Image from the DivorceCorp web site, www.divorcecorp.com

Divorce is big business. Many people can have a hand in the divorce process: lawyers, mediators, custody evaluators, therapists, court systems, and others all say they want to help divorcing couples. And all want to be paid for their services. The entire system can suffer from what might rightly be called perverse incentives — strong pulls for people to act in ways that are more out of self-interest than the true long-term best interest of the couple they claim to be trying to help.

This is the thrust of the documentary DivorceCorp, opening in major cities January 10. The movie looks good and important. Dr. Drew narrates, and it features interviews with some well-known law experts, including Gloria Allred. Here’s the trailer:

More information on the film, including local theaters showing the film when it opens, can be found on the official DivorceCorp website.

One cautionary note, though: The opening statement in the trailer, “50% of all US marriages end in divorce,” is wrong. As you can read about in more detail over at the excellent DivorceSource web site, the US divorce rate probably never topped 41% and has been declining for several years. As Tara Parker-Pope documented quite well in her book For Better, divorce rates are especially low among those with at least a college education. Over Twitter, the film’s reps have said that there were bigger fish to fry, so to speak. I get that. They’re looking at an entire divorce industry, and my caution is with one statistic. I believe the social conversation about the divorce rate is one specific part of the larger social conversation about divorce that especially needs to change, for reasons I’ll save for a separate post, but don’t let that take you away from the big picture. I’m happy to support the film and eager to see it.

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How to make a better therapist

It isn’t experience, and it isn’t the kind of training we usually do.

I’m blogging this week from the Evolution of Psychotherapy Conference in Anaheim, where many of the world’s leaders in psychotherapy gather to discuss the state of the field and share new and innovative research findings.

Therapy is tremendously effective. The average treated client ends up better off than 80% of untreated people with similar problems. Psychotherapy for mental health problems is as effective as coronary bypass surgery for heart problems and four times as effective as flouride toothpaste in preventing dental problems. But we’re not getting better, Scott Miller said in yesterday’s opening workshop.

Miller summarizes our field’s efforts to figure this out thusly: We started by looking at our treatment models, hoping to build better techniques to reach better outcomes. This is where many training programs still live: We teach manualized, empirically-supported treatments in hopes that it will make for the most effective therapists. Except it doesn’t; the models formalize and standardize our work, but they don’t make us any more effective, according to outcome studies.

So we then moved to looking at common factors, those things that work across all theoretical models. But teaching common factors doesn’t seem to make us more effective, nor does it relieve the need to know specific models, since it is through those models that the common factors work. (My good friend Sean Davis has the leading text on common factors in couple and family therapy, and in it he makes the same point.)

So the focus then shifted to the study of outcomes rather than methods, and what we found was that some therapists consistently achieve better outcomes than their peers. That has moved the field into a close examination of excellence and expertise.

The findings there are striking, and I can’t do them full justice here — I’ll address the training issues in more detail in a future post. But the short version is this: We don’t spend a ton of time training students to do the things that actually seem to make them better therapists (“better” here meaning more effective). Miller cited a vast literature identifying deliberate practice — not just more hours seeing clients, but significant time focused on reviewing weaknesses in those sessions while not actively in them and then taking action to address those weaknesses — as the key task in making people more effective. What I hear in my therapy-teacher framework: We need to be doing a lot more videotaping.

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Whose conscience matters?

When can a therapist decide their own morals and values outweigh those of their clients?

The AAMFT has kindly made my article on conscience clause laws in mental health the cover story for the September issue of Family Therapy Magazine. You can read the article here if you’re an AAMFT member.

Of course I’m biased here, but I think you’ll find it worth the read. While I’ve written about the topic a few times here on the blog (most recently, I wrote about conscience clause laws being considered in Washington, Texas, Arizona, and Michigan), my focus here has been much narrower than it is in the magazine. In the FTM piece I take a broad look at the issue, from the origins of conscience clauses to the best arguments for and against them. While these laws are often spurred by a desire to protect religious practitioners, you don’t need to be religious to be impacted by them, and you might be surprised at what the laws would appear to allow:

Most conscience clause laws are so broadly written that they could allow […] therapists to refuse to treat sexually active unmarried couples, or therapists morally opposed to immigration to refuse treatment to clients based on nationality, even in a mental health emergency.

Is this a price worth paying to protect therapists’ moral views? My skepticism is raised when considering that the religious practitioners and legislators backing these bills often seem to have a desire to legitimize discrimination against gay and lesbian clients. So, you know, that’s not okay. But the issue isn’t black and white, as I hope the magazine article illustrates.

In addition to the main article, a sidebar I had written about conscience clause laws being considered or adopted in various states around the country was transformed into a really cool national map infographic. I wish I could take credit for that — it’s great visual layout — but that’s all magazine staff. Check it out.

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I have another article in the works proposing a way therapists could consider the appropriateness of a conscience-based referral, within the fuzzy boundaries of existing law and the existing AAMFT Code of Ethics. So stay tuned for that (for several months, in all likelihood, but I’ll keep you updated).

Your comments are welcome. You can post them in the comments below, or email me at ben[at]bencaldwell[dot]com.

No, counseling psychology is not a terrible major in college

Of course salary numbers in mental health look bad when you leave out people with the graduate degrees necessary to practice.

US CurrencyNPR ran a story last month punctuated by a graph of the highest- and lowest-earning college majors. The worst on the list, by far, was Counseling Psychology. Those who majored in Counseling Psych brought in a median income of under $30,000 per year.

No one gets into mental health care for the money, but the numbers were a black eye for the Counseling field — the American Counseling Association has even responded by commissioning its own study of salaries among its members.

But there was a big problem with that original chart, one that the researchers themselves had noted but which was often ignored in discussions of their findings: It didn’t include people with graduate degrees.

In just about any mental health field, you need at least a master’s degree to practice. Those who don’t take that extra step are often limited to very basic, entry-level jobs with little hope for advancement.

So NPR is back this week with another chart, one that includes graduate-degree earners. And Counseling Psychology no longer shows up on the list of the 10 lowest-earning undergraduate majors. Counseling Psych majors get a big bump in median incomes when you include those who go on to advanced degrees, as should be expected.

Notably, social work stayed in the bottom 10, even when those who get their graduate degrees are included. Their median incomes went from just under $40,000 a year (with graduate degree earners excluded) to about $45,000 a year (with graduate degree earners included).

It’s hard to place family therapy here, since MFTs come from a wide variety of undergraduate majors, most commonly (but by no means exclusively) psychology or family studies. For MFT salary data, the best place to start is this Bureau of Labor Statistics page.

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Is “relationship orientation” a thing?

A session on plural families at last week’s AAMFT Annual Conference in Portland used the term as a parallel to sexual orientation.

Teens from polygamous families
One of the workshops I attended at last week’s AAMFT Annual Conference focused on “plural families” — family structures that involve more than two partners and their children. The presenters argued that members of these families (seen most often in the US in Colorado, Nevada, and Utah, in offshoots of the Mormon church, which officially banned polygamy more than 120 years ago) may well wind up in a family therapist’s office, and that the therapist needs to be prepared to work with the realities of their complex family structures.

The presentation was fascinating, and appropriately non-controversial: These presenters were not arguing that a plural family structure was right or wrong, just that it exists, and that therapists may be confronted with it. Fair enough.

What piqued my interest was their use of the term “relationship orientation” to describe one’s leanings toward monogamous or polygamous relationships. Are we moving toward considering a preference for monogamy or polygamy as simply one more demographic variable, not subject to change and worthy of equal respect in all its forms?

In a pair of essays for Slate, Michael Carey (a pseudonym) has argued that exact thing. He first suggests that, like gays and lesbians, polyamorists often feel compelled to hide their relationships even from close family members for fear of judgment or even expulsion — and that the lack of societal acceptance reflects prejudice. In the second, he notes that half to two-thirds of polyamorists do not experience their relationship orientation as a choice. (These numbers are from Carey’s experience, and he doesn’t pretend they are research-based.) For this majority, their “innate personality traits make it very difficult to live happily in a monogamous relationship but relatively easy to be happy in an open one.”

Don’t focus too much on that word “innate,” though. How much of a desire for polyamory is nature and how much of it is nurture isn’t especially important when arguing for moral acceptance of poly relationships, Carey argues:

Nobody ever claimed that Mildred and Richard Loving were born with some kind of overwhelming predisposition to prefer partners of another race and that they thus couldn’t marry somebody of their own race. Choosing an interracial partner was, and is, a choice. So what? The correct response to the nature vs. nurture question is: There’s no way to know for sure, and it doesn’t matter. What matters is that people love each other, treat each other with respect, and live happy, productive lives.

Now, I should be up front about my own moral place here. I have no problem with poly relationships as long as there is no dishonesty involved and no one is getting hurt (at least, no more so than happens in the normal course of monogamous relationships). What concerns me here is where the parallel leads us. If “relationship orientation” is as inflexible as we now understand sexual orientation to be, and if participants in poly relationships are not being any more or less moral than anyone else, do we have a societal moral obligation to honor poly relationships with equal status as monogamous ones (whether straight or gay)?

In other words, do we owe them plural marriage?

The overwhelming science on gay and lesbian couples show that they and their children are harmed by societal discrimination and suffer from being unable to marry in a wide variety of ways. This is in spite of the fact that children of same-sex couples are just as healthy as those from straight couples.

The situation is different for poly marriage. While there may be many exceptions, poly relationships are generally understood to be oppressive to women, and polygamous families and cultures may have negative outcomes for children on a variety of measures. So there is ample reason to take a very cautious approach to polyamorists pushing for societal acceptance.

Status of polygamy worldwide
Legal status of polygamy worldwide (click the image for full details)

I’ll admit I have never been a big believer in the “slippery slope” line of reasoning, which essentially argues that if you raise the speed limit from 55 to 65, then you’re going to have to raise it to 200. You don’t, of course; raising it again even to 70 would be a different debate. Slippery slope arguments are often nonsensical fear tactics used to argue for the status quo, by suggesting that the alternative is an extreme alternate reality that no one has actually suggested. Applied to gay marriage, some argued that it would somehow logically follow that if we allowed same-sex couples to marry, we would then have to allow people to marry box turtles.

It is debatable whether re-legalizing polygamy equates with raising the speed limit to 70, or whether it would be more like raising the limit to 200. For now, I’m looking at it more like 200 — a radical and potentially damaging change.

But lots of people once felt that way about gay marriage, too. And it seems the language debate we once had around sexual orientation being a preference, a lifestyle, or an orientation is starting to replicate itself for plural families. As we saw with gay marriage, the outcome of the language debate has a lot to do with shaping what happens next.

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Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.