California’s MFT Clinical Exam is still a test of reading speed

By Ryan McGilchrist [CC BY-SA 2.0 (], via Wikimedia CommonsCalifornia debuts its new exams for MFT licensure this week, reorganizing its exam process into an MFT Law and Ethics Exam and an MFT Clinical Exam. The Law & Ethics Exam is taken at the intern stage, while the MFT Clinical Exam is completed after 3,000 hours of supervised experience have been completed.

I’m no fan of licensing exams (seriously, read Saving Psychotherapy), but I think this restructuring is generally good. Unfortunately, one of the biggest problems with the old Written Clinical Vignette Exam remains unsolved. Like the old WCV, the new MFT Clinical Exam is apparently so wordy that it serves partly as a test of reading speed, rather than serving its intended purpose as a test of knowledge required to practice independently.

The Candidate Handbook for the Clinical Exam includes six sample questions, intended to give examinees a sense of the structure and difficulty level of actual test questions. Together, these six sample questions and their response options are about 900 words (the specific total depends on whether you count hyphenated words as multiples, whether question numbers are included, and so forth). That’s roughly 150 words per question.

As best as I can gather from some quick Googling, the average native English speaker reads at about 200 words per minute. If we take those sample items as representative of the full 170-item test, it would mean that completing the full test would require an average reading speed of just 106.25 words per minute (170 items * 150 words-per-item / 240 minutes for the exam). So an average reader would do just fine. Even if you allow 30 seconds per question for an examinee to think about the question they have just read and select the right answer, an examinee could still read as slowly as 165 words per minute and make it through.

But those who don’t speak English natively may read at 100 words per minute or slower, particularly when working to comprehend high-level professional language. And at present, the BBS offers no accommodation for non-native speakers.* This is part of the reason why those whose native language is not English are at a serious disadvantage on licensing exams, even though their reading speed has no relation whatsoever with the ability to practice psychotherapy safely enough to serve the public. Remember, there is no evidence that license exams make professions safer — but there is evidence that exams shut out minority populations.

Like many states, California has a shortage of mental health providers who can speak multiple languages and meet the needs of a diverse population. English-language reading speed is not a requirement for the safe and effective practice of psychotherapy. It’s time we stopped having it as a requirement to get licensed.

In the meantime, if you are a non-native English speaker preparing to take California’s MFT licensing exams, one of the best things you can do is work on improving your English reading speed and comprehension.

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* – The BBS is working on offering additional exam time for those who have limited English proficiency. Their efforts are worth supporting. My intent here isn’t to criticize the BBS or any other licensing board, but rather to point out the disconnect between the exam’s intended purpose and its actual impact. This problem is by no means limited to the MFT Clinical Exam or to the state of California.