Ben Caldwell

CAMFT sues California licensing board

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CAMFT is suing the Board of Behavioral Sciences (BBS), demanding a ruling that the practice of marriage and family therapy has nothing unique to offer.

See updates below: The court sided with the BBS on two out of three legal questions and CAMFT on the other. The ruling required the BBS to consult with the state’s Office of Professional Examination Services prior to determining whether a gap exam was necessary. OPES recommended doing the exam, and the BBS voted unanimously to do a gap exam.

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The California Association of Marriage and Family Therapists (CAMFT) followed through on an earlier threat and filed suit this week against the state’s licensing board, the Board of Behavioral Sciences (BBS). CAMFT is seeking a ruling that marriage and family therapists who wish to be grandparented into licensure as Professional Clinical Counselors (LPCCs) will not need to take an exam on the differences in practice between those professions. But the issue is bigger than it may sound: Such a ruling would require the BBS to first determine that there are no differences in practice between the professions, a ruling that would have major implications for the future of professional licensing in mental health.

But let’s start with where this is now. The law that brings the LPCC license into the state is quite clear (emphasis mine):

The board and the Office of Professional Examination Services shall jointly develop an examination on the differences, if any differences exist, between the following:
   (A) The practice of professional clinical counseling and the practice of marriage and family therapy.
   (B) The practice of professional clinical counseling and the practice of clinical social work.
– California Business & Professions Code section 4999.54(b)(1)

CAMFT argues in its suit, as it has in BBS meetings, that there may be differences between the professions, but that these do not amount to differences in practice. So they do not believe that an exam on differences between MFT and LPCC (a “gap exam”) is necessary. That argument has now lost twice: The BBS ruled on July 28 that there should be a gap exam, based on the language of the law. CAMFT threatened to sue (page 6), and the BBS vacated all earlier discussion and took the issue up again on September 9. Again they ruled that there must be a test. In a suit filed on Monday, CAMFT argues that requiring a gap exam amounts to an unlawful restraint of trade for MFTs seeking LPCC licensure. They ask to have the BBS decision again vacated, and an injunction issued preventing the BBS from requiring a gap exam.

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While I am trying to present these facts as neutrally as possible, I am hardly an objective observer. I co-signed AAMFT-CA’s letter to the BBS encouraging them to revisit their initial decision in May that no gap exam would be needed. And, fundamentally, I believe there are significant differences between the professions — that’s why we have distinct educational programs and are distinctly licensed. Arguing that the professions may be different but their practices — the doing of the professions — is the same is a giant leap of both language and logic. Indeed, as Dean Porter, head of the California Coalition for Counselor Licensure, has said, proving LPCCs’ distinctiveness [currently-third item, “AMHCA lauds…”] was one of their biggest challenges in achieving licensure in California.

There is no need for a separate license if the professional group in question has nothing new or different to offer. That is why this is such a concern for me — if CAMFT gets their way, and the BBS or a court rules that there are no differences in practice between the professions, it is an extremely short logical walk to an argument that MFTs and LPCCs (and even LCSWs) should not be separately licensed. I worry that that’s the idea. CAMFT has stopped publicly advocating such a shift (they openly projected such a “one-license future” to members and to the California legislature in 2007), but they still seem to be walking down that road. Having earlier removed their opposition to LPCC licensing legislation, they appear to have taken no action when a 2008 version of the LPCC bill proposed to study eliminating the MFT license entirely (see Section 6, at the bottom of the next-to-last page; that version of the bill, thankfully, failed). This week’s legal action seems to be a continuation of the “we have nothing unique to offer, so let’s all combine licenses” philosophy. Why an association of marriage and family therapists would continue taking stances that appear to act against keeping the MFT license distinct is beyond my understanding.

I would love a different explanation, but cannot seem to come up with one.

The legal complaint and related documents can be downloaded here *. They are referenced by case number (34-2010-80000689).

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I know I say this over to the right, but it bears repeating: On this blog, I speak strictly for myself, and not my employers or contractors or anyone else. It also bears repeating, for those of you from outside California, that CAMFT is an independent organization with no ties to the American Association for Marriage and Family Therapy (AAMFT) or its California Division (AAMFT-CA).

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* Updated 1-11-2011: Updated link.

Updated 2-3-2011: The court has issued its ruling, which sides with the BBS on two out of three legal questions and CAMFT on the other. See this post for details: Ruling mixed on CAMFT-BBS “gap exam” lawsuit.

Updated 2-27-2011: OPES recommended doing the exam, and the BBS has voted unanimously to do a gap exam.

Insights from 5 1/2 years of California MFT license exam data: Part II

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In part one, we learned that there are huge differences between programs in how their graduates perform on California’s MFT licensing exams. Here, we’ll see how for-profit programs measure up. You may be surprised.

For-profit universities have come under scrutiny in the past few years for aggressive recruiting practices and high costs. While the overwhelming majority of marriage and family therapy graduate programs are non-profit (either public or private), here in California a few programs are in the business of education to make money.

Some of the scrutiny faced by for-profit universities revolves around whether they are so eager to bring in new students that they accept unqualified students who cannot succeed in their fields. Since MFT licensure requires an examination that every applicant takes, we have a handy, easily-measured research question:

How do graduates of for-profit MFT programs perform on state licensing exams, compared to graduates of non-profit programs?

From this list of for-profit colleges and universities, we can identify at least four for-profit MFT programs in California:

  1. University of Phoenix – San Diego
  2. University of Phoenix – Sacramento
  3. Argosy University
  4. California Southern University

These programs, as it turns out, are widely varied when it comes to their graduates’ exam performance.

Table 1: Pass rate, CA Standard Written Exam, Graduates of for-profit MFT programs

Considering the better-than-average performance of Argosy graduates and the worse-than-average (but by no means abysmal) performance of Phoenix graduates, it seems that little can be safely concluded about an MFT program simply on the basis of its for-profit/non-profit status. So here are three money-centered things I would ask any program, for-profit or not, about if I were a prospective student:

  • A true accounting of costs. For-profit programs may be expensive, but non-profit programs can be too. Unfortunately, it is not as simple as asking “How much is the tuition?” Availability of financial aid should be a factor, particularly the question of how much aid comes in the form of loans (which need to be paid back) versus scholarships or grants (which do not). It also may be wise to ask about additional costs separate from tuition (books, fees), and whether the program will make you eligible for various stipend and loan reimbursement programs offered at the county, state, and federal levels. Students at for-profit universities appear to have particular difficulty repaying their loans.
  • Graduation rates. If programs (for-profit or not) are, in fact, admitting students who cannot succeed, that may not show up on licensing exam data; the students simply would never get that far. A key criticism of for-profit programs has been that they suffer high dropout rates, leaving students with additional debt but no additional job qualifications to show for it. Ask how many students actually complete the program relative to those who start.
  • Where your money goes. You want the bulk of your tuition money to support your learning. How much does the program spend on faculty salaries, learning technology, and other support for student learning, as opposed to administration, investments, or other costs? Naturally, some other costs are needed for any program to function. But as a general rule, the bulk of your tuition money should be going toward those things that most directly impact your educational experience.

Elsewhere on this blog I’ve described some other factors that may help you choose the best MFT graduate program for you. The questions here are more financial in nature. They’re all worth asking about.

Ultimately, I would not dismiss any of these programs simply because of their for-profit status. Any of them may be the right fit for you. Ask questions, and make sure any decision you make on a graduate education is a well-informed one.

Should you pursue a doctorate in MFT?

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Have you considered pursuing a doctorate in marriage and family therapy? There are at least three good reasons why you should.

Like many programs, where I teach (Alliant) we offer both masters and doctoral degrees in marriage and family therapy. Many of our masters students spend significant time in their second year weighing out this question:

Will pursuing a doctoral degree in MFT be worth the time, energy, and money it takes to get all the way through it?

Obviously, it is a decision that needs to be made with careful consideration of individual circumstances. Not everyone will benefit the same way from getting a doctorate in MFT. And it is highly unlikely to be a good investment if you start a doctorate and do not finish it. But depending on what you want to do with your career, completing a doctoral program could be the best investment you ever make. Here are three reasons why.

  • You can do more with a doctoral degree than a masters. With a doctorate, you may be more likely to secure a university teaching position, either full-time or as an adjunct faculty. In clinic settings, MFTs with doctoral degrees may be more likely to be elevated to supervisory or program-director roles. For tasks that an MFT can do only with additional training, such as psychological testing (laws differ on this from state to state), doctoral programs may provide that training. Finally, depending on the specifics of your state and the type of doctorate you pursue (i.e., Psychology with an emphasis in family therapy versus simply MFT), you may be able to license as a Psychologist, which can offer a broader scope of practice.
     
  • You are likely to make significantly more money with a doctorate than with a masters degree. The gap in MFT salaries between those with masters degrees and those with doctorates in the field is growing significantly, at least in California. I’ve referenced this previously, but it is worth repeating:

    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 annual incomes rise by almost $10,000, from $62,885 in 2004 to $72,165 in 2010. [See my cautionary notes about this data here.]

    This may be because MFTs with doctorates are performing different tasks and roles, as noted above, or it may be that MFTs with doctoral degrees are getting paid more even when in the same roles as colleagues with masters degrees. Here are two reasons why the latter is at least a possibility: (1) If you license as a psychologist (see above), insurers may reimburse you at a higher rate; (2) In private practice settings, regardless of your licensure, private-pay clients may be willing to pay you more because they see “PhD” or “PsyD” or “DMFT” after your name.
     

  • Better clinical understanding. When I began my doctoral program, it was not to make more money or to work my way into a teaching position. It was because I wanted to be a better therapist. There is no doubt in my mind that my doctoral program helped me to do just that. My understanding of theory, and ability to effectively apply it in session, both improved by leaps and bounds. Even if I had sought out a career specifically in private practice, I would have served my clients far more effectively with my doctorate than I would have with a masters. And that would have been enough for me to call it a good investment.

    Since then, a number of professional doors have opened to me as a result of the doctorate that would not have otherwise, and I’m thrilled that things have turned out the way they have! But even if they had not, I still would have been wise to get my PsyD.

Of course, as I said above, a doctoral degree is not for everyone. If what you want to do with your career is get into the mental health workforce, get licensed as quickly as possible, and focus on delivering effective clinical services, the clinical-skill benefits of the doctorate may or may not ultimately be worth the investment. On the other hand, if you have any interest in teaching or doing research, a doctorate will help you significantly. And if you have any other motivations to seek (or avoid) the doctorate, take them honestly into consideration. Only you can decide what is the best path for you.

Reference:
Riemersma, M. (2010). The typical California MFT: 2010 CAMFT member practice and demographic survey. The Therapist, 22(4), 28-36.

Insights from 5 1/2 years of California MFT license exam data: Part I

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California’s 80-ish degree-granting MFT programs are hard to compare. While there are minimum curriculum standards every program must meet, each has its own personality, its own goals, and its own structure. For prospective students, it can be difficult to figure out which programs offer them the best chances of success in the field. There’s really only one common yardstick that every student, from every program, ultimately gets measured on: Licensing exams.

California’s Board of Behavioral Sciences routinely publishes licensing exam success rates for each program in the state, in six-month increments. The most recent data can be viewed on their web site for the Standard Written Exam and the Written Clinical Vignette Exam. However, the small sample sizes that result from using six-month intervals make meaningful comparison difficult; smaller programs are particularly prone to large swings in their graduates’ exam pass rates from one six-month period to the next.

I gathered the BBS data going all the way back to 2004 to see whether bigger sample sizes might allow for some more solid conclusions — or at least better-informed guesses — about how MFT programs around the state compare to one another.

Before we dive in, some pretty major caveats need to be put forward. (1) My student assistants and I did the best we could to cross-check and validate the data, but we cannot guarantee that we did a perfect job. You are cordially invited to check our work (details at the end of this post). (2) Lots of factors influence the exam pass rates of a particular school’s graduates, separate from the quality of education. There are the program’s choices about whom to admit; graduates’ experiences in supervision; decisions by students about whether to pursue MFT licensure; and on and on. So if a program’s graduates performed especially well or poorly, that does not necessarily mean that the program itself performs that way. (3) To whatever degree exam passing-or-failing does reflect on a program itself, it reflects on that program’s performance several years prior to the exam. When you’re looking at data going back to 2004, as we are here, we’re considering the impact of an education received as far back as around 2000, possibly even earlier. Programs change. (4) If you’re a prospective MFT student, exam pass rates are certainly not the only things to consider when choosing an MFT program. They can be useful to include in your decision-making, but please do not let them be a powerful factor.

Got all that? Great! With those cautionary notes in mind, let’s dive in. We’ll focus here on the first licensing exam, the Standard Written Exam.

I’ve had student assistants input and cross-check the data, and we’ve done some analysis using Excel and SPSS (now PASW, for statistical-software purists) programs. The data shows some clear trends.

  • There are big differences between programs. Don’t let anyone tell you that graduate programs are basically interchangeable. They may all be subject to the same MFT curriculum requirements, but some appear to be far more effective than others in preparing their students for the licensing exams. (Education is not the only influence on exam preparedness, of course, but this data does suggest that it is a meaningful one.)

    Note: Try as I might, I could not get the tables to display well inline here. So they’ve been shifted over to the MFTEducation.com server, where they display properly. -bc

    Table 1: Best and worst performing programs*, California MFT Standard Written Exam, 1/1/2004-6/30/2009 (Minimum 50 first-time examinees)

  • Accreditation matters. Graduates of COAMFTE-accredited programs were more successful on licensing exams than graduates of non-COAMFTE programs. While my own program at Alliant International University did better than the state average, much of the COAMFTE benefit seems to come from the strength of the University of San Diego. (I have a more detailed exploration of the link between program accreditation and licensing exam success in press at the Journal of Marital and Family Therapy.)

    Table 2: COAMFTE-accredited programs*, California MFT Standard Written Exam, 1/1/2004-6/30/2009
    * – Accredited as of 1/1/2004.

  • Size doesn’t matter. Graduates of smaller programs did no better or worse overall than graduates of bigger programs. And the biggest programs were not necessarily the best. Far from it, in fact. Graduates of National University, the state’s largest MFT program by number of examinees, performed well below state averages on the Standard Written Exam:

    Table 3: Most first-time examinees, California MFT Standard Written Exam, 1/1/2004-6/30/2009

These are only the beginning, of course. There is a lot to be gleaned from the available data, for programs and prospective students alike. I’ll be doing some additional posts with more comparisons here in the coming weeks to illustrate some more of the interesting (I hope!) things we found.

One big plus about working with BBS data is that it’s all public information. So I feel an obligation to make sure others can review it, call out any errors you find, and do additional research with it as you see fit. All of the information on which these tables were based is available now at www.MFTeducation.com. There you will find the BBS source documents that we put together, as well as a searchable database so you can compare your program with others around the state. Your comments and suggestions are always welcome; I hope this is a useful resource!

Coming in Part II: Comparing for-profit programs with not-for-profit.

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

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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.