Ben Caldwell

Teen texting study an example of a researcher misleading the media

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A new study connects the texting habits of teenagers with drug use and other risky behavior. Contrary to media reports, the study did not show texting to cause the teens’ risk-taking.

Teenagers who send more than 120 text messages a day are more likely than their peers to engage in a variety of risky behaviors, including sexual activity, smoking, drinking, and drug use. That much we can agree on. It was the key finding of a Case Western Reserve University School of Medicine study presented this week.

Media coverage was predictably breathless:

But there is a big problem with each of the stories linked above. As compelling as these stories are, texting did not cause poor health or risky behaviors in this study. More precisely, the study did not show a cause-effect relationship. It found correlations — associations between certain behaviors that tend to rise and fall together. It did not say what causes what.

If we know that one behavior (texting, in this case) is more common among people who also do another behavior (let’s use drinking), then we can say the two behaviors are correlated. But that leaves at least three very different possibilities when it comes to cause and effect:

  1. Texting causes drinking.
  2. Drinking causes texting.
  3. Some other thing (lack of parental supervision, maybe?) causes both drinking and texting.

A correlational study (like this one) does not tell us which of those three possibilities is most likely (the third strikes me as by far the most plausible). And reporters understand that conclusions about correlation are not especially enticing news stories. “This one thing is related to this other thing, but we do not really know what causes either one of them” makes for a lousy article.

So reporters sometimes go beyond what a study actually shows, and pull a cause-effect relationship out of thin air. In essence, they pick their favorite out of the three possibilities listed above, and run with it. They do this in spite of a complete lack of data supporting their conclusion over the other cause-effect possibilities.

That seems to be what happened here. What is unusual in this case is the degree to which the study’s lead author actively promoted the made-up conclusion.

Even though the press release about the teen-texting study largely uses the right terms in describing the results (labeling behaviors as being “associated with” each other), Scott Frank, the lead author of the study, was remarkably cavalier in determining a cause-effect relationship his study did not demonstrate. He is quoted in that same press release as saying

“When left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers.”

The medical school where the study was conducted is also encouraging this unsupported conclusion. The link to this study from the Case Western School of Medicine home page currently reads “Hyper-texting and Hyper-Networking Pose New Health Risks for Teens.”

Frank’s promotion of a conclusion his own data does not support prompted an unusually direct rebuke from John Grohol, the CEO of PsychCentral, whose own site had reported on the study earlier. Grohol wrote that Frank’s conclusions about texting having negative health effects are (emphasis Grohol’s)

all pure crap. You could just as easily write the following headlines:

Teens Who Smoke, Drink Also Text a Lot
Outgoing Teens Like to Do Things Outgoing Teens Like to Do
Teens Who Enjoy Sex Like to Text Too!

Scott Frank, MD, MS should be ashamed of himself.

I’m with Grohol on this. For Frank to say that texting can have negative health effects is, as Grohol put it, “sloppy at best, and unethical at worst.” Frank is promoting a conclusion his study simply does not support. And some media outlets appear to be all too happy to run a story confirming parents’ worst fears about teenagers and technology, even when the story and the data do not match.

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In deference to my journalist friends, it must be noted that the examples of poor media coverage above are far outweighed, in both quantity and quality, by the many stories covering this study that ignored Frank’s quotes and reported his results accurately. Search “teenagers texting drinking” on Google’s news site and you will find far more headlines using phrases like “linked to” or “associated with” than you will find “causes.” Kudos to those writers (of both the stories and the headlines, since they are often not the same person) who understand the difference.

Quitting CAMFT

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CAMFT’s LPCC “gap exam” lawsuit against the BBS is a waste of resources that, if CAMFT “wins,” would eliminate California’s legal recognition of the distinctiveness of the MFT license. I refuse to let my member dues support it.

As I reported here recently, the California Association of Marriage and Family Therapists (CAMFT, which is independent of AAMFT and its California Division) has filed suit against the Board of Behavioral Sciences, alleging that their decision to require a “gap exam” for MFTs seeking grandparenting into LPCC licensure amounts to an illegal restraint of trade.

If CAMFT loses, it would mean they wasted thousands of dollars of member dues on outside counsel and court fees.

But if they “win,” the outcome would be far worse: It would eliminate legal recognition of any distinction between the practices of MFT and professional clinical counseling — and pave the way for the MFT license to disappear completely. (Here’s why.)

And either way, CAMFT’s conduct around the issue has already damaged the organization’s ability to work collaboratively with the BBS. [Page 50, item III on the linked PDF.]

Why CAMFT would want to win this argument, I do not know. But I know my member dues cannot support it.

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I have been an active and supportive member of CAMFT for several years. As I have talked with students and colleagues around the state, I have been able to honestly say that there is much to be proud of in the work CAMFT has done — even this year, legislation CAMFT sponsored to clarify MFTs’ roles and responsibilities around child abuse reporting has been good for the profession. Their in-house attorneys are wonderful resources, available any time. And at the chapter level, the overwhelming majority of CAMFT members simply want to be able to make a living providing providing the most effective services possible to their clients. They’re great people and often outstanding therapists.

The organizational decisions CAMFT has made, though, have too often been in direct conflict with the best interests of the profession. CAMFT’s struggle around same-sex marriage is well-worn territory here, and it speaks to larger structural problems that were apparently never meaningfully addressed. CAMFT has stopped publicly advocating for the complete elimination of the MFT license, but they continue to make decisions that lead in that direction — like this lawsuit — and I do not believe most members know just how close they have come to making it happen.

This lawsuit over a gap exam, if successful, would put the state on the record as determining there are no differences in practice between MFT and LPCC. Not only is that fundamentally wrong, but it also would virtually force the BBS to consolidate the MFT and LPCC licenses. (If there is no difference in practice, there is no need for independent licensure.) It would not happen immediately — the process would take years — but with a CAMFT “victory” in this case, it would be almost impossible to prevent.

I am a marriage and family therapist. Not a professional clinical counselor. There is a difference. Even the counselors say so. [See currently-third item, “AMHCA lauds…”] I should never have to remind a professional association of MFTs that this is true. And I cannot support one more dime of my money being used to chip away at what makes this profession unique and valuable.

So I am, with a great deal of disappointment, resigning my membership in CAMFT. I hope they get back on the right track at some point in the future. My letter resigning my membership, which largely repeats these same points, follows in its entirety.

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November 1, 2010

Dear CAMFT,

Effective immediately, please cancel my membership.

Over the past several years, I have gradually lost my faith that the organization’s goals and actions are truly in the best interest of the MFT profession. Your lawsuit against the BBS over the “gap exam” for MFTs seeking grandparenting into LPCC licensure only confirms that you are actively working against what is best for the field of marriage and family therapy.

If unsuccessful, this lawsuit will be a massive waste of members’ dues in a misguided cause. If successful, the outcome would be even worse: A legal determination that there is no difference in practice between MFT and LPCC (and perhaps LCSW as well) would pave the way for license consolidation. While this may be in the best interest of CAMFT as an organization (you could add LPCC members under one umbrella), it is quite clearly not in the best interest of marriage and family therapy as a profession. Independent licensure provides valuable legal recognition of the distinctiveness of our skill set and body of knowledge. A short “gap exam” for grandparenting appropriately balances the need to recognize this distinctiveness with the desire among some experienced MFTs who are otherwise prepared for LPCC licensure to obtain that distinct license.

Regardless of its outcome, the lawsuit has harmed CAMFT’s ability to effectively work collaboratively with the BBS. This was made clear when, at the September BBS meeting, several board members openly and publicly expressed their disappointment with CAMFT’s conduct.

I cannot in good conscience allow my dues money to be used for efforts that work against the best interests of the profession of marriage and family therapy. I will happily rejoin if and when CAMFT (1) drops this misguided lawsuit; (2) makes a clear and public statement that it recognizes the practice of marriage and family therapy is distinct from other mental health professions; and (3) outlines and follows through on clear steps to protect, preserve and advance the distinctiveness of our profession.

Sincerely,

 
Benjamin Caldwell, PsyD

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.