Ah, the Golden State. Home to me and half the licensed Marriage and Family Therapists in the country. And, in the eyes of the rest of the country, some pretty weird practices within the profession.
MFT licensure in California looks a lot different here than it does everywhere else. And it shouldn’t have to, seeing as the profession itself — that is, our scope of practice and competence — is pretty much the same here as it is everywhere else.
If you’re considering a career in mental health, there’s some good news on the economic front. After stagnation associated with the larger economy’s downturn, salaries in mental health professions appear to be back on the rise.
According to the federal Bureau of Labor Statistics, salaries are improving for all of the mental health professions except Psychology, which has been effectively flat since 2009. There are several cautionary notes that go with this data (more on those below), but if you’re considering a master’s degree in counseling, clinical social work, or family therapy, overall it’s promising:
Source data: Bureau of Labor Statistics
Note that the y-axis there starts at $40k, so it’s a little misleading as to proportionality but shows year-over-year changes more clearly.
The news seems to be especially good for MFTs in California (I’m one of them, so I’m incredibly biased on this): From 2012 to 2013, the mean annual wage for MFTs here went from $47,230 to $54,470. That’s an increase of more than 15% in just a year.
As I said, some pesky cautionary notes: First, the BLS data assumes full-time work, calculating the average annual wage by multiplying the mean hourly wage by 2,080. There are benefits and drawbacks to that approach; it keeps the mean from being dragged down by part-time workers, but also arguably overestimates what the average worker actually makes, since many do work part-time. Second, there is significant state-by-state variability in the numbers. Even if the national means are improving, it can be worth checking to see what the trend is within your state. Third, especially in states with smaller populations of mental health professionals, it isn’t unusual to see big gains or drops in a year simply due to small sample sizes. Data for larger states is more reliable. Finally, the BLS data isn’t perfectly broken down by license; the data shown here uses the BLS categories of Mental Health Counselors (21-1014); Clinical, Counseling, and School Psychologists (19-3031); Marriage and Family Therapists (21-1013); and Mental Health and Substance Abuse Social Workers (21-1023). These are the categories most focused on mental health services and thus the closest parallels to licensure.
There should be a new data set for 2014 out within a couple of months; I’ll update this post once that data is available.
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Your comments here are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.
It’s expensive and takes a long time, but job prospects are good. Is that enough?
While the job outlook remains good for MFTs — one of the reasons family therapy continues to be rated among the top careers to go into — the barriers to entry are high and getting higher. Graduate school tuition costs are rising (and it’s often hard to get accurate information about graduate tuition); pre-licensed, post-degree therapists (called “associates” in some states and “interns” in others) typically work under supervision for several years, often for little to no money, even though some unpaid MFT internships may be illegal; and these days in California, even after you finish your supervised experience you have to wait seven months or more for the licensing board to get around to your application to take the exams.
Is it all worth it?
I would say yes, but then, of course I would say yes. I’ve made, dare I say, a relatively good and stable career of being an MFT, and it is work that I love. At the same time, the environment when I came into the profession was different than it is today, and I was lucky in many ways. I got my bachelor’s degree without student loan debt, for example, which is today the exception and not the rule. California’s MFT curriculum requirements were not as tough then as they are now, requiring many to spend more time in school and pay more in tuition. (I’ve never needed to take a second job outside of the therapy world to pay the rent.) And when I applied to take the licensing exams, I didn’t have to twiddle my thumbs for another half-year waiting. So I only know my own experience, and I’m not in a good place to speak to how it is for new therapists. That’s where you come in.
In today’s environment, is it worth it to go through the struggle to become a family therapist? I was inspired to ask by a pair of articles making the rounds online: One arguing that Generation Y is made up of whiners with entitlement issues, and a counterpoint arguing that GenY is drowning in debt and poor prospects for improving their lives. Both are good articles. And Generation Y is made up of those born between roughly the late 1970s and the mid 1990s — so if you are in graduate school now, there’s a good chance you are part of that generation.
I would love to hear your stories of the struggles and rewards of becoming an MFT. If you’re new to the field and a part of Generation Y, what joys and struggles have you experienced so far, and what are your future expectations for success, salary, and happiness? If you’re an MFT veteran who is not part of that generation, how would you advise the GenYers coming into the field today? Post in the comments below or by email to me at ben[at]bencaldwell[dot]com.
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Bear in mind that by sharing your story, you’re granting permission for me to use it, with your name and with some editing if needed, here on the blog. I might also use it in other projects (as one example, I might forward it to AAMFT-CA for consideration in their work), with proper attribution of course. Thanks!
Okay, a bit of a rant today. In the family therapy world, I often hear criticism of the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic guide published by the American Psychiatric Association and currently on its fifth edition (DSM-5). This usually comes from students first learning about the DSM and its history, and in those students the criticism is often based more on anxiety than on any real substantive problem with the book.
Students are understandably anxious when confronted with the complexity of diagnosis and the power that comes with being able to diagnose a client as mentally ill. Unfortunately, I see too many MFTs who never get past that initial anxiety, and use it as an excuse for avoiding the DSM well into their professional careers. I don’t begrudge anyone their anxiety, I just wish people would own it for what it is (kind of like with licensing exams), instead of making up or latching onto an easily-refuted argument against learning and using the DSM appropriately.
The arguments against DSM use that I hear in the MFT world tend to reflect poor understanding of both the DSM and family therapy. Those arguments typically fall into three groups, listed here with their easy counters:
“The DSM is based on individuals, and I work with families.” The DSM offers labels for common sets of symptoms. That is, it gives you a quick name for sets of problematic behaviors that often occur together. It is agnostic about the source of those symptoms. It does not, contrary to some therapists’ opinions, make a presumption that the source of suffering lies within the individual. The way the DSM is written, depression could be caused by something within an individual, by problems in couple or family functioning, or by aliens. You’re free to maintain your systemic ideas about how depression often originates and is sustained (ideas I agree with, just so we’re clear) without any concern that these ideas conflict with the DSM. They don’t. Furthermore, a good systemic therapist does not ignore individual functioning; indeed, one needs to be keenly aware of how individuals are functioning within a system in order to understand the system itself.
“A diagnosis is just a label, and I don’t like labeling people.” Nonsense. Any time you call someone by their name, you are using a label for them. Labeling is a good and healthy and awesome thing that we do in human societies to keep language relatively efficient. If you really hate labels, and prefer to capture the whole essence of things (many of those I have heard say they avoid the DSM say that they do so to better capture the “whole person”), then when you go home tonight I want you to announce to whomever is close by that for dinner you will be having semolina, flour, eggs, and water, all formed, cut into long needle shapes, and dried, and then resoftened in boiling water for a few minutes, topped with pulverized tomatoes that have themselves been heated and mixed with spices and possibly some kind of meat or cut mushrooms. Served steaming hot! Then you can take pride, when they tell you “um, that’s spaghetti,” that you have captured the entire essence of the pasta. You’ve also needlessly wasted everyone’s time.
Listen, use of a label doesn’t constrain you to only using that label, nor does it mean the label is all there is of someone. I hope that when doing therapy, you really do maintain a thorough sense of your clients’ strengths and resources and personalities far beyond what you can gather from a simple diagnosis. But use the label too. It is essential for other health care providers, who may need to know the nature of someone’s symptoms very quickly (like in an emergency), that you know enough about symptoms and diagnoses that you can tell them, without taking the next 15 minutes to describe someone’s essence as a human being.
“The DSM is pathologizing, and I try to focus in therapy on depathologizing behavior.” I have the most empathy for this argument, as family therapists are particularly inclined to see even diagnosable behaviors as adaptive to their context. But it still falls pretty flat. Yes, the DSM is pathologizing, insofar as it describes symptom clusters as mental disorders. Expanding criteria for mental illness contributes to what Szasz labels the medicalization of everyday life. And there is much to be said about the misuse of DSM diagnoses across cultures.
But go back to the first argument here. Remember, the DSM is agnostic as to the source of symptoms. The fact that the behaviors that together add up to a diagnosis of, say, depression are actually adaptive responses to family dysfunction does not make the diagnostic label incorrect — the individual really is displaying those symptoms — and it doesn’t mean that the individual should not receive treatment. Indeed, one of the upsides of broadening diagnostic criteria is that they allow people to receive treatment, often paid for by their insurance company, when they previously could not have. In other words, that individual diagnostic label (which, again, is just a description for a symptom set, not a theory about the cause of the symptoms) is often the very thing that allows you to treat the system.
There are larger debates to be had about the role of the DSM in mental health care, and even more broadly, how our entire health care system is structured around diagnosis and dysfunction rather than a foundation of keeping people well. And there certainly is plenty to criticize about the DSM. But for where we are now, let’s all agree that (1) diagnosing is important enough that it’s okay to be anxious about it, and (2) the act of assessing and diagnosing an accordance with the DSM is in no way inconsistent with family systems work. In fact, it’s a requirement for doing that work well.
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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. You’ll also find a some very insightful comments on this article over on my Facebook page.
The draft standards would restore the 500-client-contact-hour requirement for practicum. Under the current, version 11.0 standards, programs can require fewer hours as long as they have evidence to show that their practicum results in students being competent to practice at the master’s level. This vague standard has left different accredited programs using different experience requirements, which can be confusing to state licensing boards who want to know how much practical experience they can reasonably expect to be included in graduate degrees.
The draft standards separate accreditation requirements into “eligibility standards” and “accreditation standards.” As it is now, the Commission makes its decisions based on the full scope of information presented to them. Programs that meet most but not all standards may still be granted accreditation, with stipulations — requirements that the program comes into full compliance with the standards within a year. This proposed split into eligibility and accreditation standards arguably makes the accreditation bar a bit higher: Programs that fail to meet even one of the eligibility standards would not be eligible for accreditation, regardless of their performance on the other standards.
The draft standards would go back to a singular, mandatory core curriculum for all accredited programs. Of course, programs would remain free to add on to this core curriculum as they see fit, but all accredited programs would be required to have the same core set of coursework.
Perhaps what is most notable in the draft standards is what is missing: The draft standards remove COAMFTE’s current vague, blanket exemption for religious programs. The exemption, present in the current COAMFTE standards (p. 3), says
Religiously affiliated institutions that have core beliefs directed toward conduct within their communities are entitled to protect those beliefs.
It has never been clear to me what that is supposed to mean in practice, but the way I read it, any religious-based program that wants COAMFTE accreditation but isn’t in tune with any part of the standards was free to ignore that part of the standards, as long as they could tie their objection to their religious beliefs. Under the proposed new standards, not only would that clause go away, but the required curriculum would include at least three semester units on
diversity, power, privilege and oppression as they relate to race, age, gender, ethnicity, sexual orientation, gender identity, socioeconomic status, disability, health status, religious and spiritual practices, nation of origin or other relevant social categories throughout the curriculum. It includes practice with diverse, international, multicultural, marginalized, and/or underserved communities, including LGTBQ affirmative practices. [emphasis in original]
It is much clearer what the new standards would mean: Every COAMFTE-accredited program would need to teach its students how to work with LGBTQ clients in a positive, affirming way, and an appreciation for the harm such clients suffer from living in a heterosexist society.
To me, these are all good and necessary changes. First, as to the hours and curriculum changes: I hear chatter among MFTs around the country that licensing boards haven’t known what to do with the current COAMFTE standards. Those current standards are so flexible that licensing boards don’t necessarily know what they’re getting when someone comes to them with a COAMFTE-accredited degree. The draft standards, if adopted, would bring back greater consistency in content across programs and could restore state boards’ confidence in maintaining COAMFTE accreditation as the standard educational requirement for licensure.
Second, as to the removal of the religious exception: I’ve written previously about the struggles some religious therapists face when trying to work with LGBT clients, and the debate there is far from settled. But accredited programs can and should teach affirmative practices. The debate here should be restricted to how a therapist balances their values with client needs in the therapy room, not about whether the therapist can be exempted from exposure to affirmative techniques or to the suffering LGBTQ clients genuinely experience.
There’s only one thing COAMFTE didn’t included that I wish they would: Require MFT programs to be more transparent about cost.
COAMFTE will be reviewing comments on the proposed changes this fall. If adopted, the new standards would likely take effect in 2014 for new accreditations and be phased in for those programs already accredited.