Licensure Archives - Page 16 of 17

The first interstate compact for counselor license reciprocity

April 20, 2015March 26, 2015 by Ben Caldwell

I’ve talked a fair amount in this blog about the need for better license portability across states. True license reciprocity, where one state automatically recognizes another state’s licensure, is rightly the long-term goal of some professional associations in mental health. (I’ve argued that telehealth will help us get there.)

Counselor and therapist licensure: Does testing raise quality?

November 17, 2014August 23, 2014 by Ben Caldwell

Whenever I get into conversations about the licensing process, a number of the same questions keep coming up. Many of these questions revolve around the value of having a license exam. It’s perhaps the most pesky, the-answer-should-be-obvious-but-isn’t question: Do licensure examinations make for better therapists?

Training in mental health is unreasonably long

November 18, 2014March 13, 2014 by Ben Caldwell

Just as a quick thought experiment, go over to this piece at Slate discussing medical training, and every time it references “medicine” change that to “mental health.” (Accordingly, change “physicians” and “doctors” to “therapists.”) You’ll find most of it applies perfectly. To wit:

Over the past century, there have been additions to, but few subtractions from, the training process. Residency and fellowship programs became longer and longer … and longer.

and

The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges.

and

The fundamental problem here is that the argument between traditionalists and reformers [debating the appropriate length of training] is essentially theoretical — we are in an evidence vacuum.

In the time I’ve been in academia, I’ve watched as the requirements for training in mental health have increased dramatically. Family therapist training in California increased from 48 to 60 units based not on science but on workplace competitiveness. (MFTs were fighting clinical social workers for some of the same jobs, and since LCSWs need 60 units of training, MFTs couldn’t really argue that their training at 48 units was equivalent.) I’ve also watched as education in general has gotten much more expensive, and loans harder to come by. And I’ve been enlightened by learning that our 3,000-hour supervised training requirement is based entirely on tradition, and is in virtually no way linked to the science that we now have available (though admittedly, it isn’t much) on how therapist skill develops over time.

Our old apprenticeship model is broken. It’s as true in therapy as it is in medicine. It will be interesting to see how experimentation with medical training goes, as it can blaze the trail for similar efforts in other health care professions like ours. I’m just not sure we should be waiting for doctors to do it first.

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What’s the difference between an MFT (or LMFT), an LPC (or LPCC), and an LCSW?

January 7, 2019October 15, 2012 by Ben Caldwell

Even many professionals don’t understand what the difference is between their profession and another. State laws vary when it comes to scope of practice, but the professions are distinctly licensed everywhere in the US for good reason.

Basics of California Law 5th edition cover

Note: The following is a slightly-modified excerpt from my chapter on Scope of Practice in Basics of California Law for LMFTs, LPCCs, and LCSWs. Learn more about the book or purchase the current (2018) fifth edition here.

I frequently hear the argument (particularly here in California) that there are no meaningful differences among the mental health professions. After all, each of the master’s-level mental health professions can assess, diagnose, and treat the full range of mental and emotional disorders in the Diagnostic and Statistical Manual through the use of psychotherapy. So why do we even have different licenses?

This argument usually comes from therapists who were trained and supervised primarily by members of other professions. To be sure, one can get licensed as an LMFT or LPCC without ever having been supervised by someone in the same profession. (Clinical Social Workers in California do have to have some of their pre-license experience supervised specifically by LCSWs.) However, I would argue that being supervised outside of one’s own profession is not ideal preparation for one to really become a member of that profession. LMFTs typically do not know how social workers are trained, what texts they read, and how they are brought into the social work field. The same could be said for any other cross-disciplinary understanding. While the masters-level mental health professions often perform similar work functions, they do so from very different underlying philosophies.

The act of defining these professions for the sake of licensure is hardly a distant memory. LMFTs and LPCCs each had states where their professions were not licensed until 2009, when Montana (LMFTs) and California (LPCCs) passed laws that completed 50 states of licensure for each profession. In the years before, as LPCCs and LMFTs went around the country arguing for distinct licensure in each state, both professions regularly made the argument that the two operate from distinct histories, distinct skill sets, and distinct bodies of knowledge.

To understand the differences succinctly, let’s start from a problem. Let’s say that Diego is a 38-year-old Latino man who is married and works in a bookstore. He comes to therapy with severe anxiety. The different mental health professions will likely start from very different places as they seek to answer the question, “Why is Diego struggling with anxiety?”

Psychology

Although this article does not focus on Psychologists, understanding their perspective can be helpful. A traditional Psychologist would examine Diego’s inner world to find the root of his dysfunction. Whether looking to his childhood (as a Freudian would) or looking to his present (as a behaviorist would), the focus will be on Diego as an individual. Furthermore, traditional psychology would focus on pathology – rooting out what is wrong with Diego individually.

Professional Clinical Counseling

The professional clinical counseling field emerged from school and career counseling. While they focus today on mental health, LPCCs are likely to see Diego’s struggle as an individual, developmental issue. They will examine his psychological and social development and his current functioning, and treatment will focus on helping Diego improve overall development and wellness (including treatment of mental illness).

Clinical Social Work

Clinical social workers place their focus on connecting people with the resources they need to function well. Those resources may be internal (such as personal skills and strengths, some of which Diego may not be utilizing to their potential) or external (such as community resources and support groups). Traditionally speaking, LCSWs are likely to see Diego’s struggle as a resource issue, and will work with Diego to gather the internal and external resources needed for him to control and ultimately overcome his anxiety.

Marriage and Family Therapy

LMFTs look at behavior in its social and relational context. Perhaps Diego’s anxiety has emerged as a result of tension in his work or in his relationships. Perhaps his anxiety is even adaptive when considered in its context – for example, if he receives more support from his boss or from his partner when showing outward signs of anxiety. Ultimately, LMFTs believe that no behavior exists in a social vacuum, and will work with Diego – as well as other family members and other important people in Diego’s life, if appropriate – in an effort to make the anxiety no longer necessary.

Areas of overlap

As you can see, none of these philosophies is any better or worse than the others. They’re just different. That matters a great deal as new professionals are being trained and socialized into their respective professions. Of course, the perspectives above are purist ones, and even looking at things from that purist perspective, there is significant overlap between these philosophies for dealing with many problems. When handling adjustment issues with children, for example, LMFTs and LPCCs may work very similarly.

Each of these fields has also been influenced by the others. Using Psychologists as an example, there are now Community Psychologists (who share a great deal in common with LCSWs in their approach), Family Psychologists (who share a great deal in common with LMFTs), and Counseling Psychologists (who share a great deal in common with LPCCs). The professions all benefit from this cross-pollination, which helps us communicate effectively with one another and assess clients more thoroughly. But, using LMFTs as an example, one only needs examine the core competencies for LMFTs to see where the overlap ends; even just reading through the list of skills all LMFTs are expected to be able to do, they can be broken down roughly equally into three categories:

1. Tasks that all mental health professionals should be able to do, and that all would do about the same way (for example, suicide assessment).
2. Tasks that all mental health professionals should be able to do, but LMFTs would do from a different conceptual framework (for example, general mental health assessment; MFTs would approach this from a relational mindset).
3. Tasks that LMFTs should be able to do that other mental health professionals would not necessarily be expected to do (for example, a systemic case conceptualization).

Of course, LMFTs are not superior to the other professions, nor do they have greater job functions. I’m just using LMFTs as an example. A list of core competencies for LCSWs or for LPCCs could surely be broken down into similar proportions. The point is, while we all do many of the same things in assessing, diagnosing, and treating mental illness, it is quite a disservice to the professions to suggest we are all the same.

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Originally published October 15, 2012. Last updated January 7, 2019.

How long does it take to get an MFT license?

June 11, 2018March 26, 2012 by Ben Caldwell

State laws vary, but typically, you need a two-year masters degree and two more years of full-time, supervised experience. Here are the steps to becoming a licensed family therapist.

If you are planning or considering a career as a marriage and family therapist, it is important to give thought to the time and money it will take to work your way to licensure. The timing of steps along the way could impact your choices for when to get married, have children, or maintain employment in another field.

Presented here are the typical steps to an MFT license and some common timeframes. The steps and timeframes listed here do not account for individual circumstances or the many state-to-state differences in licensure laws. You should check the web site of your state MFT licensing board (AAMFT offers a handy directory of state MFT licensing boards) to learn the specific requirements of the state where you want to license. I have some emphasis on California in this post because it is the state I call home, and because about half the MFTs in the country are here.

Note that a “typical timeframe” here means a common amount of time needed for those who are accomplishing that step through full-time work or study. If you build your career in MFT through part-time work or study, to allow you to balance family responsibilities, maintain outside employment, or for any other reason, naturally your timeframe will be longer.

Progression to licensure as a marriage and family therapist usually follows these steps:

Complete a bachelor’s degree in psychology, family studies, or a related field. Many schools will be OK with a major in a different field if you can demonstrate adequate base knowledge in psychology and family development, through specific prerequisite classes, GRE subject test scores, or other means. Typical timeframe: 4 years.
Complete a master’s degree in marriage and family therapy, counseling psychology with an emphasis in MFT, or a closely related field. Note that some states, like California, have specific requirements for what degree titles will make you eligible for MFT licensure. In most states, you will need to demonstrate that your master’s degree program was accredited by COAMFTE (the accrediting body for MFT programs), or is equivalent to COAMFTE standards. I’ve written in the past about the benefits of attending a COAMFTE-accredited program, and I’ve also offered tips for admissions interviews at MFT programs. You might want to consider a doctorate in MFT, though it will take longer. Typical timeframe (masters degree): 2-3 years.
Complete additional supervised experience under a licensed MFT. In some states, including California, other licensed mental health professionals can supervise you as well; check with your state to see what their supervision standards are. Note that some states require your pre-licensed experience to be under an AAMFT Approved Supervisor. (A directory can be found here: Find an AAMFT Approved Supervisor.) During the time between graduation and licensure, while you are working under supervision, your state may call you an “intern” or an “associate” depending on the state. A few states use other titles. Most states require a total of 3,000 hours of supervised experience for you to be eligible to sit for licensing exams; there is some variability here, too, however. (Pennsylvania’s governor just signed a bill reducing that state’s requirement to 3,000 hours from 3,600.) Some states simply phrase this as two years full-time experience or the equivalent. Also note that in California, some hours gained within the master’s degree program can count toward the 3,000 total needed for licensure. (Other states tend not to allow this.) Typical timeframe: 2 years.
Pass your state’s licensing exam(s). California is the only state that uses its own exams rather than the National MFT Exam. Many states require a state law and ethics exam in addition to the national exam, since state laws vary in key areas like child abuse reporting requirements. While an exam itself is over in a day, the licensing board needs time to process your MFT exam eligibility application, you need time to prepare, and you will need to schedule an appointment with a nearby testing facility. I’ve previously offered tips for preparing for MFT licensing exams, four myths about MFT licensing exams, and some discussion about whether MFT exam prep courses are worth the money. Typical timeframe: 6 months – 1 year. Longer if you need multiple attempts to pass.

Once you make it through that last step, congratulations! The state can now make you fully licensed as a marriage and family therapist, able to work independently in a private practice if you choose.

Overall, it’s good to plan for a total of at least 4-5 years from the start of your masters degree all the way through to licensure. Your time may be longer based on your circumstances; it would be possible (at least in CA) but unusual for your time to be any shorter.

In most states, the timelines for masters-level licensure are similar among clinical social workers, counselors, and MFTs. California is a noteworthy exception there: Only MFTs can count pre-degree hours of experience toward the 3,000 hours required for licensure, so it tends to be faster to get an MFT license in California than the other masters-level licenses. Licensing as a Psychologist requires a doctoral degree (typically 5 years, sometimes as short as 4) plus a postdoctoral internship (in California, 1,500 more hours, or about another year of full-time work) for a total of 5-6 years. Again, though, your individual circumstances may make your time longer.

Ed. note: This post originally published March 26, 2012. Some links updated June 11, 2018.