Ben Caldwell

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.

Recapping the 2010 AAMFT Annual Conference

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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

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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

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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.