Interns and associates in the master’s level mental health professions in California will take a law and ethics exam in their first year of registration, under an exam restructure taking effect in January 2016.
Note: The following is an edited excerpt from Saving Psychotherapy: How therapists can bring the talking cure back from the brink. You can buy it on Amazon.
Licensing exams do not assess your effectiveness as a therapist. They aren’t meant to. That bears repeating: License exams do not assess your effectiveness as a therapist. They are a licensing board’s best effort at assessing whether you have the minimal knowledge (not skill, knowledge) to be able to practice independently without being a danger to the public. That’s all. When therapists decry the fact that license exams are nothing like doing therapy, they’re right – and their point isn’t relevant. Exams aren’t supposed to be like therapy. If you want to know how good you are as a therapist, look elsewhere, because exams are not and are not intended to be a barometer of clinical effectiveness. They are a somewhat crude assessment of safety for independent practice.
With that aim in mind, do they work? Do licensing exams make therapists safer?
There’s remarkably little data to answer that question.
Indiana’s Religious Freedom Restoration Act, signed into law by Governor Mike Pence last week, has raised a great deal of controversy. In the psychotherapy community, the law could have an immediate impact in the form of professional events and conferences moving out of the state. In the longer term, the bill is likely to impact training and practice by making it harder for universities and licensing boards to discipline discriminatory behavior.
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.)
Alliant International University, which houses APA-accredited psychology programs and COAMFTE-accredited family therapy programs, announced last week that it has converted from a non-profit corporate structure to a benefit corporation, a new type of for-profit structure allowed in California and at least 26 other states.
In California, we’ve seen a lot of changes to state law and to the ethical codes that govern mental health practice in the past 12 months. So I’m happy to announce the new third edition of Basics of California Law for LMFTs, LPCCs, and LCSWs, updated for 2015 and available for preorder now.
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.# # # 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.
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.
|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.|
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).
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This post is a lightly-modified excerpt from Basics of California Law for LMFTs, LPCCs, and LCSWs (fifth edition), © Copyright 2018 Benjamin E. Caldwell. Reprinted here by permission.
Originally published October 15, 2012. Last updated January 7, 2019.